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HomeMy WebLinkAboutMONTGOMERY LT 5Montgomery Lot 5 #051-193-02 SAAB-HD.I GVINTER ANCHORAGE AREA BOROUr'H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 1-. LOCATIONZ-�r✓ SEPTIC TANK: INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING �" / i� ADDRESS ' LEGAL DESCRIPTION �02 .PHONE MBER OF DISTANCE FROM WELL MATERIAL /!IBJ% OMPARTMENTS C:. ��L (6)(f1 L._L. it .�� 6T LIQUID LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH LENGTH L- DEPTH LINING MATERIAL.. � 12 P(�`-�f . DISTANCE FROM WELL 1571 BUILDING FOUNDATION_�O, l NEAREST LOT LINE �� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '73c -r-) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION , NEAREST LOT LINE TOTAL , OF LENGTH LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE_ IN. ABOVE TILE l_ WELL: TYPE �tL % < <TFi DISTANCE FROM BUILDING FOUNDATION. WATER SAMPLE , NEAREST NEAREST LOT LINE SEWER LINE-, SEPTIC TANK SEEPAGE` , SYSTEM , CESSPOOL OTHER , SOURCES_ DIAGRAM OF SYSTEM DISTANCES: C J a DATE a /7 APPROVED / HEALTH AU HORITY GAAB_HD-2 GREATEH,,,iNCHORAGE AREA E-,ziR®UGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. 322- 2 , 2 2— NAME OF APPLICANT _ cJQ. K'> n 2 // MAILING ADDRESS �iG� PHONE N0. RESIDENCE ADDRESS r y`/ L LOCATION OF INSTALLATION A/ LEGAL DESCRIPTION /07- S— �/O✓I/j �/P,�'f �� ^1 APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT ,DRAIN FIELD_, OTHER TO SERVE THE FOLLOWING FACILITY -3d ee FINANCED THROUGH '3C' i F TO BE INSTALLED BY PE— N EST RESULTS ANTICIPATED DATE OF COMPLETION A f" 3�-r3z�- j44 -sass' X72- 41/4 BELOWTOBE FILLED OUT BY HEALTH DEPARTMENT C THIS IS TO SERVE AS�J�i eCr(?iU l PERMIT TO INSTALL A 7f ✓,)f !Q AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED n SEPTIC TANK SIZE 1494VO TYPE EEPA GE AREA T EE � �/f% 1%9Cry?rte//%'tel f.� DIAGRAM OF SYSTEM /if/cj 5 DISTANCES: In /N 2 z� OL o .�� hae- Authority LL I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described ystem is in accordance with said code. -Pe P-44 , 7 AXeg 7 of /S'i GATE APPLI CANTS SI G NATU R E -Lz '°-'/GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT CASE: i 327 EAGLE STREET ANCHORAGE, ALASKA 99501 Performed For 71))r Date PerformedL� Legal Description: Lot aBlock 3u,�d,t3.sfin µ This Form Reports a: Sal.ls Lop, ori Percclatio" �_ Depth Feet Sail Charac wisv us RocK� f�72 olan7joald 5TrcdaJ / fopso l (,W hos ghily �o erc e6i %iy2 z 04 e0011se s4i2d, /Ihe- 5/�a�u of 6' eons 'sls d 3 pebbles Ya/�yi/�� iv! sinei�m Ya " fo a H--� no Sated sized lJorJic/es• 64 c6b(e 7 � Gw y Location Sketch Frop,sed Instal lafion®Seepage Pit Drain Field Depth Of Inlet q Depth To Bottom Of Pit Or '?Tench j�� COMMENTS: 7ti , %_ _ 1. O - Test Performed By:, e C Data Certified iX3 F4 � I a �o g W , AU v a ? W 3 Z O _' (G ~ J J Q; O :cW 0 0 0 LL L MW W o cg LL I d LU Q 19 m idK Q w Za N r 41 19 414 ) 4 WI rci hw� rd pow rd Wf� Id ° -. w r�• V 4 $44-1 44 a ro �' o� roUi A LI 14 -. 44 rd O $4 W U a P4 d G �drta P4 Ct A O O4J 0 Q Ln W d ua 0 a d • w a w° a W , v a ? W 3 Z O _' (G ~ J J Q; O :cW ~ K a 0 LL L MW W o cg LL I Z =Zm 0 F 3 Q 19 m idK Q w Za N r Certificate of On -Site Systems Approval Parcel I.D. 051-193-02 Expiration Date: i 2 23 Legal description MONTGOMERY LOT 5 Site address 22612 Sherman Chugiak Current property owner(s) Secretary of Veterans Affairs X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 2Z 2,O Z3 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services 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 work. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory Other Well Flow Advisory Nitrate Advisory Arsenic Advisory X COSA Approval_June 2022 MUMUPAUTY OF ANCHORAGE Development Services Department ¢s Phone: 907-343-7904 On -Site Water & Wastewater Section -J Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-193-02 Complete legal description Montgomery Lot 5 Location (site address) 22612 Sherman Street, Chugiak AK, 99567 Current property owner(s) Secretary Of Verterans Affairs Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: R 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: lfo� Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic FS -1 Concrete ❑ Fiberglass Age 54 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench 0 Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal Onsite staff to verify the accuracy of the information provided. COSA Fee $ J�J�U Waiver Fee $ Date of Payment 19.6 2-:3 Date of Payment COSA # ®S C,2 3 103 5- Waiver # IF0q&1`c7 COSA Application—June 2022 Legal Description: Montgomery Lot 5 Parcel ID: 051-193-02 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth 164 ft Cased to 40+ ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 01/31/23 Static water level at beginning of test 86.0 ft Y' Comments e:ri ra'z � +c .<U(.C,t t Measured operating fluid level in septic tank NA Date of pumping 02/14/2023 ❑ Required maintenance completed, if AWWTS Comments: Concrete Tank D. ABSORPTION FIELD DATA Which system tested (date installed) 09/02/1969 ❑ ALL standpipes present per record drawing Total measured depth from grade 8.96 ft (max) Measured depth to pipe invert from grade 3.75 ft (min) ❑ N/A — pressurized field. ❑ 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 2000 gallons 02/09/2023date Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficien COSA Checklist June 2022 Well production at time of test 8_ 75 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ Nc OR Coliform bacteria is Negative Nitrate 8.18 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Sullivan Water Wells Date 01/31/2023 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 02/09/2023 Results ❑ Pass Fluid depth prior to test 26.5 in Water added 450 gal New fluid depth 47 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 Effective depth used 0 in Effective depth remaining 72 in in 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 5+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' © Yes if No ft Private Sewer/Septic Line > 25' ❑Yes if No Absorption Field on Lot > 100' r -ml Yes if No ft Holding Tank > 100' ME Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No 0 Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft Q Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5+ ft Surface Water > 100' ❑ Yes if No _ Tank to Property Line > 5' © Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No 5+ ft Private Wells > 100' M Yes if No _ Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No _ Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft ft ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Pannone Engineering Services Engineer's Printed Name Steven R Pannone P.E., F. ASCE COSA Checklist June 2022 Phone 907-745-8200 Date Nitrate Advisory Certificate of On -Site Systems Approval # OSC231035 Subdivision: Montgomery, Block: , Lot: 5 A water sample revealed a nitrate concentration of 8.18 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Municipality of Anchorage Development Services Department g4'° Building Safety Division On -Site Water and Wastewater Program { 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-193-02 COSA # i7`JG a MU S� TYPE OF WASTEWATER DISPOSAL: Expiration Date: ' - 9 - 1 1. GENERAL INFORMATION Individual On-site Complete legal description Montgomery SID, LotX5 Location (site address) 22612 Sherman Street, Chugiak, Alaska Current Property owner(s) Melvin & Gail Staudinger Day phone 230-0319 Mailing address Community On-site Lending agency Day phone Mailing address Public Sewer Real Estate Agent Laura Hamilton, ReMax of Eagle River Day phone 244-0357 Mailing Address 11525 Old Seward Highway, Eagle River, Alaska 99577 Unless otherwise requested, COSA will be held by DSD for pickup. c1 Q 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site ✓❑ Individual Water Storage ❑ Individual Holding Tank Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (pSpr Fee 4 `-A 0D z)G 4. 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 for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 andfor wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Douglas T. Kenley, P.E. Address 9806 E. Northstar Circle, Palmer, AK 99645 Engineer's Printed Name Douglas T. Kenley 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone (907) 746-1073 Date %•z3•lz Conditional approval for bedrooms, with the following dr , X49 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: o. Original Certificate Date: (Rev. 11105) Municipality Of Anchorage WIDD Development Services Department ==4 Building Safety Division Site Water 8 Wastewater Program 4100 Elmore Road P -O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MonWnerySID. Lot 5 Parcel ID: 051-193-02 A. WELL DA I H Well type p"Ta� Date completed _ Total depth 164 ft. Date of test Static water levet Well production if A, B, or C provide PWSID # _ Well Log (Y/N) N Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Cased to 46" ft. FROM WELL LOG WATER SAMPLE RESULTS: ft 9.p -m - Coliform Negative colonles/100 mL Nitrate 14.1 mg/L Arsenic: ND ug/L date of sample: 8128/12 8. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Casing height (above ground) 2 -Al in. AT INSPECTION 9/20/2012 91.2 ft 2.5 9— p.m-Collected by: F. Kenley Date installed Tank size 1000 gal. Number of Compartrnents T Cieanouts (Y/N) .,. Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 8/31/2012 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 9/2/69 Soil rating (g.p.d.tif or ff/bdrm) System type Crib Length 12 ft. Width 12 ft Gravel below pipe 6 ft Total depth 9 ft. Eff. absorption area 300 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/20/12 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 9-T/6 in. Water added454 gat. New depth T�t14 in. Elapsed Time: 218 min. Final fluid depth16-1'4 in. Absorption rate >= 450 g.p.d- Any rejuvenation treatment (past 12 mo.) (YIN 8 type) N If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at_ in. "Pump off' level at _ in. High water, alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ ft. On adjacent lots 100+ ft. Absorption field on lot 100+ ft. On adjacent kits 100+ ft. Public sewer main NIA Public sewer manholelcleanout N/A Sewer /septic service line 25+ ft. Holding tank N/A Animal containment areas 50+ ft. Manure/animal excrete storage areas 10()+ ft. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ ft. Property line 10+ft. Absorption field 5+ ft. Water main N/A Water service line 10+ ft. Surface water tau* it. Wells on adjacent lots 100+ fl. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ ft. Building foundation 10+ it Water main NSA Water Service line 10+11- Surface water 100+ ft- Driveway, parking/vehicle storage s+n. Curtain drain None Known Wells on adjacent lots 100+ ft. F. COMMENTS G. ENGINEER'S CERTIFICATION I cerfify that 1 have determined through field inspections and -0* 9 IH \ a review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name Douglas T. Kenley P.E. r T REW Date t o 2 2, CE8178 COSA Fee $ Date of Payment Receipt Number (Rev. 4/10) Waiver Fee $ _ Date of Payment Receipt Number Municipality of Anchorage hr, Community Development Department' Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 121459 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 5 of Montgomery subdivision. This inspection revealed a nitrate concentration of 14.1 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the.relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for - important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ARCTIC PUMP & WELL INC. Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: 0iko ��t� �sn[xf� `1 Jim Sullivan PO Box 770197 VNWAER xan¢srs '.)Eagle River, AK 99577 sw9 t vita — (907) 688-2510 Melvin Staudinger (907)258-2510 (907)745-25t0 PO BX 671922 apw-..oci.nct Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: 0iko ��t� �sn[xf� `1 Arctic Pump & Well, Inc. Page 1 of I Legal Description: Montgomery Property Owner Name & Address: Lot:5 Melvin Staudinger Block: PO BX 671922 ('Inmialr AK QQ577 Pump Installation Date:9-10-12 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Dempster Pump Model: Pump Size: hp Pitless Adapter Burial Depth: 9 feet Pitless Adapter Manufacturer's Name: S-50 Pitless Adapter Installer: U/K Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: casing 40'+ with no perforations Bleed back valve at 9'and 19' Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of I ARCTIC PUMP & WELL INC. Jim Sullivan PO Dox 770197 i !NAM Ea le River, AK 99577 gas smr � B � a ttrrIft (907) 688-2510 (907)258-2510 (907)745-2510 qrm "'eci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Arctic Pump & [Vell, bac. Page 1 of 1 Legal Description: Montgomery Property Owner Name & Address: Lot:5 Staudinger Melvin Block: PO BX 671922 Au 4os(7 Pump Installation Date: 10-4-12 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Dempster Pump Model: Pump Size: hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: UK Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: removed bleed valves extended casing 18" above grade grouted around casing 2' below grade mounded dirt around casing Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & [Vell, bac. Page 1 of 1 FLOOR ZONING NS TCT MOOT BUIIpNO MMAM SBE BULUNC MMAC( REM BUILWNG WMACK SHERMAN STREET N890 59'00"W 132.00' ner, f u.,• -- � -- — _x_ ............... .............. ,( AO V C�)' '.• �,4—•�♦ as mom Meo qand to Ne best of my ............... o--' '-� t M —,MM w matimam. t ImmNme M1aw ben a - }f :• WELL E. Jenne. J.. hwmY Cori, Mol I ea m M—Bumt nrwy of Ne P ••.., ,p •♦ IY "•••' MIs lot na Nat all Ne p ,�ik.0fessionol nonan .n 'aa,mmie .•I.t unlet C) ........... . ... o... ........ .......-...'... o o................. _ Z ..'G......... o .. FP. 60.8' 0 4 6 z 0 oEXISTING o No HED o HOUSE 0 0 60.8' N o 22.6' UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE SYMBOLS ❑ FOUNDATON AS -BUILT SET REBAR I ASPHALT ❑❑ FINAL SMUCTURE AS -BUILT O FOUND REBAR DRAINAGE :A_a. PLOT PLAN ... AS -BUILT ... LOT SURVEY ... TOPOGRAPHY 0 WOOD FENCE CONCRETE AS -BUILT... NO CORNERS SET RECER111A110N AS -BUILT ... NO CORNERS SET DOff ASSUMED ELEV. XT METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION PLOT PLAN ner, f u.,• M1«mY ar11H that 1 how PM1YMctlIY wimfN 0. IM cram aae.umea xn.n, ne loot naw lona « No n m a Ne lot aom.n as.'shed ,( AO V C�)' '.• �,4—•�♦ as mom Meo qand to Ne best of my . ;• '-� t M —,MM w matimam. t ImmNme M1aw ben a - }f :• H AMON AS—BUILT • �•'!+• + E•• �•,^�• E. Johne. Y.. xnWY artlfY that I 'mea nM—Bit wrwy of Me _ / n on Nle let and that al Ne • no ma mfamann as mem nROBERT ••^••••• i/J••• E HP na no n«nmm,s,<e .10 N. mnvlw. . ;• •� • 21 STRUCTURE AS—BUILT y .. fB ••••••• E. Jenne. J.. hwmY Cori, Mol I ea m M—Bumt nrwy of Ne P ••.., ,p •♦ IY "•••' MIs lot na Nat all Ne p ,�ik.0fessionol nonan .n 'aa,mmie .•I.t unlet NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 cote: 1 n C 301 Rea Lot S.F. Rec. Plat File No. ate Surveyed: 9/24/12 Drawn by REJ Checked bJMK ate Drawn: 9/24/12 Grid: 1159 W.D. 12-40811 Lot 5 MONTGOMERY ri '7 -10 -?k nv cTc�tu�F� 5. LEGAL DESCRIPTION y MUNICIPALITY OF ANCHORAGE „.,. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION - 825 L Street - Anchorage, Alaska 99501 - ENVIRONMENTAL ENGINEERING DIVISION NUMBER OF BEDROOMS Telephone 264-4720 ❑ One ❑ Four ❑ Other REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplet requests ill oit be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER 7. WATESUPPLY - PHONE Jeffrey Fraley ❑ COMMUNITY since June 1975. For wells drilled prior to that crate, give well -G&8-40=71� MAILING ADDRESS On L -D - Lt- 6M cY St. Rt. Box 959 Chugiak, Ak. 56 EJ INDIVIDUAL/ON-SITE** PROPERTY RESIDENT (If different from above)_)HONE If system is over two (2) years Did an adequacy test is required NSA Sherman -�Rd. by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 2. BUYER PHONE Rick A. Pet rman MAILING ADDRESS ST. Rt. Box Chugiak A_.; 9 67 i 3. LENDING IN! ON PHONE The Lomas & Nettleton Co. 274-46F MAILING ADDRESS 4449 Business Park Blvd. Anchora A 995 4. REALTOR/AGENT PHONE Robert Booth GnllprV of Homes 276-2766 MAI LING ADDRESS 1709 S. Bra aw 5. LEGAL DESCRIPTION Lot 5, Montgomery s/d STREET LOCATION NSA Sherman Rd. Chugiak,Ak- 99967 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other Fr -1 SINGLE FAMILY M Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six -��-~--�- 7. WATESUPPLY r INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for a.v,'Iwellsdrilled ❑ COMMUNITY since June 1975. For wells drilled prior to that crate, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM EJ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation d2e If system is over two (2) years Did an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-ulurs/i:sl MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION N 2 0 1978 RECEIVED tf- THIS SIDE FOR OFFICIAL USE ONL - INSPECTION APPOINTMENTS DATE RECEIVED - - TIME TIME TIME DATE - DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY _ ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DTANCES _.. -IS-- - WEi-L TO: -Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to neaf�st Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany,aertificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAra� DEPARTML�i OF HEALTH AND ENVIRONMEP,-,%"s.. PROTECT IONnn� )j! 825 L Street, Anchorage, Alaska 99501 I� • /' 279-251.11 ext. 224 or 225 1 Date Received: August 25, 1977 #1: Time 2:30 P.M. #2: Time � ��> #3: Time Date 8-26-77 Friday Date' _ �A Date Insp Willis Insp �� Insp REQUEST FOR APPROVAL OF' INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska National Bank of the North Mailing Address: 3301 C Street, Calais II Phone.- 2. hone; 2. Property Owner: Michael A. Davis Mailing Address: Box 959 Star Route 99567 3, Legal Description: Lot 5 Montgomery Subdivision Phone: 688-2074 4: Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Two 5. Well Sys=tem: _individual Well (x) Corrs�nunity/Public System ( ) Permit # Depth of Well ' & � � Well Log on File ( ) Construction Bacterial Analysis - 6. Sewage Disposal System: On-site System (xi Public Utility ( ) Permit # Septic Tank Size _ Installed (�_�Installer Manufacturer Absorption Area. Kia Soils Rate Material 7. Distances: Well. to Septic Tan]>> to Absorption Area ��- to Sewer. Line Nearest Lot line to Nearest Lot Line Aelte Absorption Area .. ;r e '#wb Departments of Health and Environmental Protection Request. for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Montgomery Subdivision_ Comments: Af_fadavit Attached: ( ) Letter Attached: ( ) Approved: �vV- Date- Disapproved: ate: Disapproved: Department Worksheet: Date: S__iMUNICIPALITY OF ANCHORAGES UOeaDepartment of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99.501 279-2511, ext. 224, 225' ' ueSt for Approval of Individual Sewer and Water Facil'ti2s- 1. Property Owner : ��%� I'1 bUl S i Mailing Address: i co Phone 2 . Name of Bu er : S u Mailing Address: f Phone: cr��ti� Ri`vf� /4!G 13. Lending Institution:fTS�O�%�� 'Mailing Address: Phone: I4. !Realtor/Agent: , !Mailing Address: Phone: _. -riei�T 1 5. i Legal Description:/Y(6gi-7-6-og F l/S�aa/3/>�v�s�o;-v P-467- Street Location: J1n�`�� /�/ �L� �L�w Single Family Residence: Number of Bedrooms: Q� Multiple Family Residence:/ \(') Number of Bedrooms: !Water Supply: *Individual Well Public/Community System ( ) i 'If Individual Well, well depth I iTf Community System, name of system Sewage Disposal System: On-site SystemPublic System ( ) If On-site System, date of installation: A well log is required on ALL wells drilled since 6/75. gAOCHOtAbf AYt ��� � � U ` �• t GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ���J� Date Received March 17, 1976 0-10 Time of Inspection m- c'_��� m� a /1 QoriDate of Inspection - , �i�' �� as �� REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES o FOR AHFC �� 1. Approval requested by: Security Pacific Mortgage Corporation Mailing Address. 319 West 5th Avenue 2. Property Owner: Kari & Tersa Liekoski Phone: 272-9511 Phone: 688-2850 Mailing Address: Post Office Box 525, Chugiak, 99567 3. Legal Description: Lot 5 Montgomery Subdivision 4. Location: Mile 162 Old Glenn Highway, Chugiak 5. Type of facility to be inspected Single Family No. of bedrooms 2- 6. 6. Well Data: Individual A. Type B. Depth 164' C. Construction D. Bacterial Analysis c,,122Y"2 6,� 7. Sewage Disposal System: On-site system. A. Installed 1969 B. Installer C. Septic Tank: 1. Size o-ele 2. Manufacturer &rn�� WW D. Seepage Pit: 1. Absorption Area /_Lk/ L ,y % 2. Material E. Disposal Field: Total length of lines 8. Distances: i A. Well to: Septic tank Absorption area p,!�? Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rust for Approval of Individual u r & Water Facilities r L,e-galiDEscription Lot 5 Montgomery Subdivision Comments Approved64--e&,,eovDisapproved Date 3-30--76, Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1-l,t7fClly ula6 Lam 1111 U1 niabivIi encu [n wlIQ 1c4vczo .me UFF.v.u. w .,' .. o..... w11� accurate representation of a subject sewer and water facilities and these facilities are operatin satisfacto 1 . SIGNED Date C V-llya'va EQ -034 (1/74) h1HNIC11'AI.h Y OF ANCHORAGE, -11. Of Hurl iiI Zs 31/ a a� �1y FNVIRONIMI.MA1 P't)"ff'C I()iV. R A �CH0RAGE AR;-', BoaoUc� GREATE J � r Q ;;� Deparimen o' Environ : en jai gal i t� 3330 "C" St. , Anchorage, Al as'.<a 99503 27�+- f5�, X13 f REQUEST FOR APPRO11- L OF INDIVIDUAL SE'riER � 'MATER FACILITIES - 1 . Type of Inspection: CMRO VA FHA CONV ��_ 2. Property 0wnelr ki - Mailing Address: P.O. Box 525, Chugiak Da}+ Phone688-2850 3. Name oilBuyer: Mike and Judith Davis c orage, work Mailing Address: P.O. Box 1182, Juneau O.;y Phone 344-0541 ; 4, ame Of Lending Institution: security Pacific Mrg- Corp. Mailing Address: -:319 west Fifth Ave. Phone 272-9501 5. dame of Realtor or Agent: AREA REALTORS Virginia Kohfield Nai1,ing Address :P.O. Box 249, Eagle River -Phone 694-9555 6.. Legal Description:' Montgomery. Lot '# 5 Location: Mile 16 1/2 Old Glenn Hwy. Chugiak - 7. Type of Facility to be inspected: Res. No. Bdrrns. 1 S. dater Supply Type `of' Supply: Puolic utility Individual X If Individual, number o dwe11ings. presently -served 1 If Individual, depth of well 164 9-. Sewage Disposal -System Type.of System: Public Utility Individual (on-site) X If Individual, date of installation