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T15N R1W SEC 18 LT 155 E PTN
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Wasilla-Fishhook Road Wasilla, AK 99654 (907)376-2041 Name: Georgina & Gary Richardson Address: City: Chugiak State: AK Zip Code: 99567 Well Site: T15N R1W S18 East Partition Lot/Block: L 155 Additional: 19444 Beverly Ave Well Depth: 145 ft. From: To: Formation: 0 2 stick up Below Ground: 143 ft. 2 4 topsoil Above Ground: 2 ft. 4 26 gravel & sand damp' Gal/Min: 1`5 26 44 sandstone 44 76 grey bedrock Static Level: 40' 76 82 black & green granite 82 115 grey bedrock w/ quarts Casing: 43 ft. 115' 121 green bedrock 121 138 grey bedrock Liner Pipe: 75 ft. 138 145 coal Screened: N/A Fracture 56 Perforated: ` N/A 61 73 Grouted: Grouted 2 bags 107 Depth: Develop. Method: Air WATER CpUAUTY . ESTING use of Well: Residential Coutorm ? Drilling Method: Rotary Misc: 0 Other:' The well was pumped 5' off the bottom with 100% draw down fort hours and recovered at1.5gpm Date Drilled: 09.26.22 Driller: Seth Moore Development Services Department Building Safety Division Ads,f4 -V On -Site Water & Wastewater Program 4700 Elmore Road U z P.O. Box 196650 1" Mark Begich Anchorage, AK 99507 Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW OSP221360 Date of Issue: 09/12/22 Parcel Identification Number:051-231-54 Legal Description Property Owner Name & Address: T15N R1 W Sec 18 Lt 155 East Partion Georgiana & Gary Richardson 19444 Beverly Ave 19444 Beverly Ave, Chugiak, AK Chugiak, AK 99567 Pump Installation Date: 09/26/2022 Pump Intake Depth Below Top of Well Casing: 125 Pump Manufacturer's Name: Meyers Pump Model: 3/4hp 5gpm 230v Pump Size 314 hp Pitless Adapter Burial Depth: 13 feet Pitless Adapter Manufacturer's Name: campbell Pitless Adapter Installer: Unknown Well Disinfected Upon Completion? © Yes ❑ No Method of Disinfection: sterilene Comments: Pump Installer Name: Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 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 Water System Permit cnt WL 9E n � "v Department Permit Number: OSP221360 Effective Date: Work Type: Well Upgrade Expiration Date: Tax Code Number: 05123154000 Site Legal Address: T15N R1 W SEC 18 LT 155 E PTN G:1055 Site Mailing Address: 19444 BEVERLY AVE, Chugiak Owner: RICHARDSON GEORGINA SHADAY & Lot Size in Sq Ft: Design Engineer: FORGE ENGINEERING Total Bedrooms: This permit is for the construction of: 9/12/2022 9/12/2023 54450 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy 0 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 Received By: Date: �l Issued By: _ tin., Date: 2 ��I�MHMPAUTi Y OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-231-54 Property owner(s) Georgina & Gary Richardson Day phone Mailing address 17634 SE 196th Dr, Renton, WA 98058 Site address 19444 Beverly Ave Legal description (Sub'd., Block & Lot) T1 5N R1 W Section 18 Lot 155, East Partition Legal description (Township, Range & Section) Lot Size 54,450 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ElUpgrade ❑x Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 1- (Signature of property owner or authorized agent) ermiUS Fees: 02r—+ OS = ;,�1�o— Waiver Fees: Date of Payment: Ot 10q 12,Q Date of Payment: Receipt Number:C7 oma Receipt Number: Permit No. Waiver No. Permit App_ - :- .-.,:c September 8, 2022 CYE E E R I N G binicipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COIVPUAN( OSP221360, Ross IWffsinWr, 09/121 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T15N R1W Section 18 Lot 155, East Partition -19444 Beverly Ave Septic system design Dear On -Site Services Engineer: The owner of the above lot has a water well that has stopped producing, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the exiting well, new well and septic system locations. No conflicts exist between this proposed well and the septic systems, whether on this lot or adjacent lots. Please refer to the attached plan for the proposed location. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE T1 5N R1 W SECTION 18 LOT 155, EAST PAF��a r&ECOM IUA OSP221360, Ross Noffsi Wr, 091 I LOT 1528 / / LOT 152A I LOT 153 ENSURE 100' SEPARATION FROM I / / I SEPTIC SYSTEM >100' FROM EXISTING SEPTIC SYSTEM / I PROPERTY LINE --------------! / / I ------L.-/'----- / / / / FFORGE------ '�� -1/r ENGINEERING B�/E;RLY ERIVE 33' BLM ROAD R.O.W. & EASEMENTRESERVE—/ I 1 I 1 1 NEW WELL LOCATION W o N \ • 11 I I EXISTING SEPTIC SYSTEM I 1 LOT 155 EAST APPROX LOCATION OF SEPTIC SYSTEM LOT 173 � A�\\\ �1� NOTE: ALL WELLS ON SURROUNDING LOTS ���'••..�y�ti •.�'•* WITH IMPACTS TO THIS // PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC Ar �I9 TM SYSTEMS. �.•. Benja i Schiller �� / 1�1�'srF.•.0 9.8a292,.����r� 0 50 100 11\�` ROFESSIONP�� \ 111=50' \ LOT 173 � A�\\\ �1� NOTE: ALL WELLS ON SURROUNDING LOTS ���'••..�y�ti •.�'•* WITH IMPACTS TO THIS // PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC Ar �I9 TM SYSTEMS. �.•. Benja i Schiller �� / 1�1�'srF.•.0 9.8a292,.����r� 0 50 100 11\�` ROFESSIONP�� FEET 111=50' \` �EXISTINGkW'iILL / I I / I I I � I � I I 1 I � I / I I / I / / 1 / / \ \ LOT 154 \ I L_ --- LOT 174 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE Municipality of Anchorage Community Development Department Pagel of 3 On -Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191458 PID Number: 051-231-54 ❑ New ! Upgrade Name: ANNA NOWAK ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ■ Bed ❑ Mound Address: 19444 BEVERLY AVE., CHUGIAK, AK 99567 ❑ Other Phone: No. of Bedrooms: soil Rating: Total Depth from original grade: 907-350-1630 3 0.7 GPD/Sq. Ft 6.8 (MAX.) Ft LEGAL DESCRIPTION Depth to pipe Invert from original grade: Gravel depth beneath pipe: SEE DWG. Ft 0.5 Ft Subdivision: Block: Lot: Fill added above original grade: Gravel length: - - 155 E PTN SEE DWG. 45+ Ft FL Township: 15N Range: 1W Section: 18 Gravel width: Beds Number of lines: Distance between lines: 15 Ft 3 5 Ft SEPARATIONDISTANCES Total absorption area: 675+ Number of trenches: - Dist between trenches: - To Septic Absorption Lift Holding PubllcfPdvate From Tank Field Station Tank sewer Lines SQ. Ft FL well 100'+ 100'+ - - 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer. Capacity. Surface water 100'+ 100'+ - - GREER TANK 1000 Gal. Lot Line 5'+ 10'+ - - N/A Material: Number of compartments: HDPE PLASTIC 2 LIFT STATION Foundation 10'+ 10'+ - Manufacturer. Ca Gal. Curtain Drain NONE KNOWN Remarks: 2.2 FEET OF MOA SAND FILTER BELOW TOTAL DEPTH. Pump on level at "Pump off level at High water alarm at Pump Make & Model, Electrical Inspections performed by. PIPE MATERIAL D3034 House to tank (FOR NEW) Tank to D3034 drainfield Installer WILCO EXCAVATION Drainfield D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft Inspection Location and Description: Dates: 1st 11/4/2019 2nd 11/5/2019 3rd 11/5/2019 4th 11/6/2019 MAN DOOR THRESHOLD - CLOSEST TO NEW TANK ENGINEER'S SEAL Community Development Department Approval ••'� 0 %tt4 '��.•'''' ••..�o Conditional approval: Date: : * ••' �' �e %.....3....;49 j:. ................ �....... ...... .1 .... ......... .......� i rJe rA. G�rn ss a �, r CE17953 ' ?s ♦j♦'�O �,� yrs. l Approved: Date: pp p..�� ,�NP�:oi RO0 s LICENSE,��1',;; �0•� ME C8 Inspection Report _1-1-12doc 11PARCEL NUMBER:OSP9458 RECORD DRAWING 051-231-54 N / SCALE: / 1"=30' / WELL RADIUS WELL RADIUS i BEVERLY AVENUE / / EXISTING WELL I I I � A \ INSTALLED DOUBLE \ CLEANOUTS (DBL1 & DBL2)- \ i GARDEN \ AREA EXISTING 3 BEDROOM GARNESS ENGINEERING GROUP, Ltd =-__------ CIVIL & ENVIRONMENTAL ENGINEERS,=�� --- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 338-3246' WEBSITE: www.games engineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANNA NOWAK 907-350-1630 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: T15N, R1W, SECTION 18; LOT 155 E PTN J.L.M. TYPE OF WORK: DATE: �, RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 11/20/2019 / / / 1100' WELL RADIUS ,i -BENCHMARK - I MAN DOOR THRESHOLD = 100.00 \ \ — rMT3 — — CO7 C041 ICO2 NEW 1000 GALLON 0051 IC03 GREER SEPTIC TANK C061 MT2J i i `MT4---- ---- �� < i 1 INSTALLED DOUBLE I CLEANOUTS (DBL3 & DBL4) I NEW DRAINFIELD I APPROXIMATE LOCATION OF OLD CRIB AND TRENCHES. CRIB WAS FILLED WITH DIRT AND DRAINFIELDS WERE DECOMMISSIONED IN PLACE PER CONTRACTOR. NOTE: OLD SEPTIC TANK AND CRIB WERE DECOMMISSIONED PER UPC PER THE CONTRACTOR. GARNESS ENGINEERING GROUP, Ltd =-__------ CIVIL & ENVIRONMENTAL ENGINEERS,=�� --- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 338-3246' WEBSITE: www.games engineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANNA NOWAK 907-350-1630 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: T15N, R1W, SECTION 18; LOT 155 E PTN J.L.M. TYPE OF WORK: DATE: �, RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 11/20/2019 / / / 1100' WELL RADIUS ,i -BENCHMARK - I MAN DOOR THRESHOLD = 100.00 \ \ E°S$ sono =gTT'Z=�R�] zyr� A A O O n O:U Uoa vBz a�xom zo ow ;o y0 m > m So 4 0 �P z Z O y Oa cn A f0 2 C m �a z ro- V yi a fan '7i fpAy bza.� p 6 i T 1 a O �T m D;y .y mj O 0 „ m g �• i Mo TO o 0 o m ( m 0 ZD C m D. A pA CC �p z I 00 ma� ],U1 z D m03 Z r C ap�i 9 A �D A 22 TD 4aI � -1 JC30 00 Oni "-IO -mi� rog z mm y a p a u vt� N� L�DN x a Ls S c \l � a r t7iN > o u O = Z s e o Z' mz _jMo n 0 " Mo om=`m ompo mn ooh 44, . a$®o f" '•''• �' PREPARED FOR: ANNA NOWAK r' ;OO 0`N'c.=��d •. s ,p �7 �v �7�v �T GARNESS El��. INEE �7 i GROUP Lid, PHONE NUMBER: (907)350-1630 ci O,i;�l a A o ENGINEERINGoSALESaCONSULTING "¢.o yr c,o•.ac.�war .x xarrwri 9 PAG30F3ENUM R . 0 �• F'^•�'-,••/• ,• 004' LEGAL DESCRIPTION; T15N, R1W, SECTION 18; LOT 155rE PTN DRAWN BY: J.L.M. ®/ ` ; O®O'~ ggtt'sai TYPE OF WORK DATE +'o RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 11/20/2019 w o am N co Q I TA tit ON 5 ° l4 � X41 `r41 'n cn 49 IL J � rl cra ct t� tt E- MW j ia w t�ilO�0 15 U ®� ��g C9 �?- �Juwiggzca wfx z,<a. p�p o�Wfl :U - w aWw Z 120 0 COR Gcl)��;a. ��o tw wQ � �19 f5 z 03 w®���-cwaZ W- © \tU� �clw i Q ,�, 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://wvjw.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191458 Work Type: Septic Upgrade Tax Code Number: 05123154000 Site Legal Address: T1 5N R1 W SEC 18 LT 155 E PTN G:1055 Site Mailing Address: 19444 BEVERLY AVE, Chugiak Owner: NOWAK BOGDAN & ANNA Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date ,�1�1CIIj �J f� Dopa rtmeut Lot Size in Sq Ft Total Bedrooms: 10/14/2019 10/13/2020 54450 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: loll".5-111, Date: toh 7 ll� 3 MUNICIPALITY OF ANCHORAGE Development Services Department \�4,_.� Phone: On -Site Water & Wastewater Section ~-' Fax: ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-231-54 Property owner(s) ANNA NOWAK Day phone 907-350-1630 Mailing address 19444 BEVERLY AVENUE, CHUGIAK, AK 99567 Site address 19444 BEVERLY AVENUE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) 155 E PTN Legal description (Township, Range & Section) T15N, R1 W, SECTION 18 Lot Size . Sq. Ft. Number of Bedrooms 3 "3456 N Q� 9 O Q OC� ..lA� �/ cfpl,9 3 43-7904 tea/ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ❑ Upgrade (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy. ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. [further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner -or authorized agent) Permit/Rush Fees: -695 Waiver Fees: Date of Payment: GO/� �l �' Date of Payment: Receipt Number: Receipt Number: Permit No. 6509 1 UT? Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc GARNESS ENGINEERING GROUP, Ltd � � �-- ENGINEERING -SALES -CONSULTING. October 4, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Quaid Advanoe,17'-rr�tment Sy,iem Ref: Proposed Septic System Upgrade for T1 5N, R1 W, Section 18; Lot 155 E PTN To whom it may concern: The subject lot is served by a private well and septic system. The existing septic system consists of a 1000 gallon steel septic tank and a log crib type seepage pit with dual trenches connected to the backside of the seepage pit. The septic system is over 45 years old, and during a recent site visit, it appears the log crib appears to be collapsing. Due to age of the septic system and questionable integrity of the drainfield, the owner has requested the septic system be upgraded. We are proposing a new 1060 Infiltrator septic tank or a Greer HDPE 1000 -gallon septic tank and a bed type drainfield be installed. We are proposing the new drainfield be installed within the 30 -foot radius of TH#1. The existing septic tank and drainfield be decommissioned per UPC. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. The drainfield will be designed around the 30 -foot radius of TH#1. The percolation rate was found to be <1 minutes/inch, which requires a 2 foot sand filter. We are proposing that a 0.7 gpd/sq.ft. application rate be used for this design. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: No surface waters were observed within 100 feet of the proposed septic system. 4. TOPOGRAPHY: The topography is generally flat over the majority of the property. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact. us at 337-6179. Thank you for your assistance. /1 ly Jeffre��� Garness�FY.E., M.S. Presi 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com T15Iq RIW, I 100'WELL RADIUS �loo•� SECTION 18, I I LOT 151 5N, R1 W, SECT. ir'� 100' WELL RADIUS //J \ J CoA \`� T15N, R1 W, SECT. 18; -LOT 152B I T15N, RIW SECT. 18; LOT 152A CEEPTIC AR � I SEPTIC �\` -- �, -----.•L------ i,~------ / — — — — — — — — — — — — — — — — — — ��- — — _ 'kSfi^> w 4'F {'_rS.'.•�+t�l, +,�:�i•.r•'�i:'i.i Ti, ti•+!5.:.�fiy.:,Y. i' �BEVERLY AVENUE--------------- ------------- ------ ---- EXISTING \ i /EXISTING WELL --\ BEDROOMHOUSE -- --L n-------------- �� 1 \ 100' WELL RADIUS I \ 1 TH#1 ` 100' WELL 'IUS PROPOSED �GA,- SEPTIC SYSTEM I i ' I i i I I ' I 100' WELL RA[ I I \ \\\ T15N, R1 W, SECT. 18; LOT 173 I ` Ii CSEPTIC ARE!tD``\`— SEPTIC SYSTEM T15N, R1 W, SEAT. 18; LOT 154 i i i CSEPTIC ARE N SCALE: 1"=100' -------------- T1 5N, ------------- GARNESS ENGINEERING GROUP, Ltd - - —_-- - -- - _-- 1 ENGINEERING o SALES o CONSULTING =- 3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK 99507 - PHONE (907) 337-6179 - FAX (907) 338.3246 - WEBSITE: www.gamessengineedng.mm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANNA NOWAK 350-1630 1 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: T15N, R1 W, SECTION 18, LOT 155 E PTN J.L.M. TYPE OF WORK: DATE: SITE PLAN FOR PROPOSED SEPTIC UPGRADE 10/4/2019 T15N, R1 W, SECr..,48; LOT 174 Not * . 49�i • * 1 . ..�... .... .........•... ...'' . .. %■ 0,:, e y . am ss ' .v. CFf79q3 AIF G� • ♦♦ pROFc,z E LICENSE 11It Ilk alk #AECC884 GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER / THAT PERTAINS TO THIS DESIGN. BY PROCEEDING / FORWARD WITH THIS INSTALLATION, THE / ENGINEER, WELL DRILLER, CONTRACTOR AND / PROPERTY OWNER AGREE THAT THEY HAVE / READ THESE SPECIFICATIONS AND AGREE TO / ACCEPT THE TERMS AND CONDITIONS OUTLINED. / DESIGN CRITERIA: NUMBER OF BEDROOMS: 3 GALLONS PER DAY (GPD): 450 PERCOLATION RATE/S: <1 MINUTE/INCH PROPOSED APP. RATE: 0.7 GPD/SQ.FT. MINIMUM DRAINFIELD SQ.FT.: 643 DRAINFIELD DESIGN: MAXIMUM DEPTH: SEE DETAIL DRAWING WIDTH: 15 FEET LENGTH: 45 FEET M.O.A. APPROVED SAND FILTER: 2.2 FEET EFFECTIVE: 0.5 FEET REDUCTION FACTOR: N/A ACTUAL SQ.FT.: 675 I I I I I I \ I \\ I / N = su- / BEVERLY AVENUE EXISTING WELL 100' WELL RADIUS I I I I EXISTING \ 3 BEDROOM \ HOUSE \ EXISTING CLEANOUT. \ CONNECT NEW 4" SEWER LINE \ AT THIS POINT AND INSTALL \ DOUBLE CLEANOUTS NOTE: ALL SEPTIC PIPES AND TEST HOLE NOTE: THE CONTRACTOR SHALL HAVE THE 100 WERE SWING -TIED INTO THE HOUSE CORNERS FOOT WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. GARNESS ENGINEERING GROUP, Ltd - _ _---- - CIVIL & ENVIRONMENTAL ENGINEERS— _--_- _- -- _- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 • FAX (907) 338.3246' WEBSITE: www.gamessengineeflng.com PREPARED FOR: \\ GARDEN X100' WELL RADIUS ��� AREA 907-350-1630 2 OF 3 PROJECT/LEGAL DESCRIPTION: EXISTING SEPTIC TANK TO BE T15N, R1 W, SECTION 18; LOT 155 E PTN J.L.M. DECOMMISSIONED PER UPC /-100' WELL RADIUS DATE: DESIGN OF SEPTIC SYSTEM UPGRADE 10/4/2019 TH#1,rh -------- ---------- SIZ7 -----9r I // CO CO I / lll��i 1 I o CML• n� PROPOSED 1060 INFILTRATOR `----------- - TANK OR 1000 GALLON GREER i > SEPTIC TANK I < i I INSTALL DOUBLE CLEANOUTS I PROPOSED DRAINFIELD (SEE DESIGN CRITERIA) � I APPROXIMATE LOCATION OF � EXISTING CRIB (BELIEVED TO BE COLLAPSING) AND TRENCHES. f DRAINFIELDS TO BE DECOMMISSIONED IN PLACE. NOTE: ALL SEPTIC PIPES AND TEST HOLE NOTE: THE CONTRACTOR SHALL HAVE THE 100 WERE SWING -TIED INTO THE HOUSE CORNERS FOOT WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. GARNESS ENGINEERING GROUP, Ltd - _ _---- - CIVIL & ENVIRONMENTAL ENGINEERS— _--_- _- -- _- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 • FAX (907) 338.3246' WEBSITE: www.gamessengineeflng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANNA NOWAK 907-350-1630 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: T15N, R1 W, SECTION 18; LOT 155 E PTN J.L.M. TYPE OF WORK: DATE: DESIGN OF SEPTIC SYSTEM UPGRADE 10/4/2019 / )100' WELL RADIUS i,—BENCHMARK- MAN DOOR THRESHOLD I = 100.00 I I \ \ \ .o�P�� OF '••�' ## .......... :.. ........... �.... �n.....TL. �.— A. IS�a�mebs E-79 3 AV ♦#j F IO1. J•'�'�•�� F'i4W LICENSE t"ROFESS\ ..�0 #AECC884 �„" 2' PROPOSED DRAINFIELD ELEVATION TABLE [®` o w U Lu Z U) g U w Z Z Q < 0— GROUNDWATER ON 10/4/2019 86.40^ MAX. EXCAVATION DEPTH BOTTOM OF SAND 89.30 TOP OF SAND FILTER/BOTTOM OF GRAVEL 91.50 INVERT OF DISTRIBUTION LINES 4" PERF. PIPE 92.00 TOP OF DRAINROCK 92.50 PROPOSED FINAL GRADE 99.00± I ea -4" MONII Y Q o CM CD 4" CLEANOI 00 w p 90° ELB( 0 Z uj Q co ccei m Lu 2i LL co N I 4" TEE (TYPIC Q Z w � z 0 z J W Q o_ (D F— d a a o 15 FEET WIDE I FROM SEPTIC TANK—� 4" CLEANO( 4" SOLID P 4" - 90' ELBC t� I 4" CLEANOI I s ��-4" MONII ♦♦. V Zw Z ?3 1 in Z� Ox DESIGN CRITERIA: NUMBER OF BEDROOMS: 3 IARK GALLONS PER DAY (GPD): 450 FOR PROJECT IS PERCOLATION RATE/S: <1 MINUTE/INCH N DOOR THRESHOLD W PROPOSED APP. RATE: 0.7 GPD/SQ.FT. MINIMUM DRAINFIELD SQ.FT.: 643 :LOSEST TO EXISTING FIC TANK) = 100.00 �q W DRAINFIELD DESIGN: WW� Lo 0 MAXIMUM DEPTH: SEE DETAIL DRAWING ; W WIDTH: 15 FEET LENGTH: 45 FEET = 98.30 `i Z. �- O LL Z M.O.A. APPROVED SAND FILTER: 2.2 FEET Za J EFFECTIVE: 0.5 FEET W pp 0 REDUCTION FACTOR: N/A ACTUAL SQ.FT.: 675 o O LL 0 O~ a0 J NOTE: THE ELEVATION OF THE INVERT OF THE PRE -TANK CLEANOUT NEAR THE HOUSE = 93.67. .���,`� QF 1�♦♦ * • 49a , .40 ON 10/4/2019/ ................ ......... .............. / / / ...... ...... ......................... 0 = 84.40. J A. S 40 - 53 Ar ♦♦♦O�F� 0`79AV � �••• ���� LICENEk` ��,OFESS��:01• #AECC884 '"� PROPOSED DRAINFIELD ELEVATION TABLE [®` o w U Lu Z U) g U w Z Z Q < 0— GROUNDWATER ON 10/4/2019 86.40^ MAX. EXCAVATION DEPTH BOTTOM OF SAND 89.30 TOP OF SAND FILTER/BOTTOM OF GRAVEL 91.50 INVERT OF DISTRIBUTION LINES 4" PERF. PIPE 92.00 TOP OF DRAINROCK 92.50 PROPOSED FINAL GRADE 99.00± O~ a0 J NOTE: THE ELEVATION OF THE INVERT OF THE PRE -TANK CLEANOUT NEAR THE HOUSE = 93.67. .���,`� QF 1�♦♦ * • 49a , .40 ON 10/4/2019/ ................ ......... .............. / / / ...... ...... ......................... 0 = 84.40. J A. S 40 - 53 Ar ♦♦♦O�F� 0`79AV � �••• ���� LICENEk` ��,OFESS��:01• #AECC884 '"� GARNESS ENGINEERING GROUP, Ltd -- - - j ENGINEERING o SALES - CONSULTING — -- - -- -- - --- 3701 E. TUDOR ROAD. SUITE 101 -ANCHORAGE. AK 99507' PHONE (907) 3376179' FAX (907) 336-3246' WEBSITE: w .games ngine Hng.mm SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: T15N, R1 W, SECTION 18; LOT 155 E PTN PERFORMED FOR: ANNA NOWAK DATE: 9/27/2019 DEPTH (feet) ORGANICS 1 LOAM (SM) 2 `!.. o... 3 , v 4— o o 5 , o 6 v 7 ", o o 8 4 0 10 o 12 o 13 , o 14 B.O.H. 15 16 17 18 GP W/ SAND • DATE DAMP SOIL @ 10' 9/27/2019 12.1' 9/30/2019 • 10/1/2019 ' IIIIIIIII 0" II�III� 3 N/NN� 6" - 4 - <1 • 6" 5 - 111111111 6" iINN Wly 6 - MORA 0" 6" 7 - - 6" ARMAll 8 <1 0" DEPTH TO GROUNDWATER DATE DAMP SOIL @ 10' 9/27/2019 12.1' 9/30/2019 12.1' 10/1/2019 11.9' 1 10/4/2019 SITE PLAN 1"=100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/30/2019 1 - 6" 2 <1 0" 6" 3 6" - 4 - <1 0" 6" 5 - - 6" 6 - <1 0" 6" 7 - - 6" _ 8 <1 0" 6" 9 _ _ 6„ _ 10 <1 0" 6" 11 6" - 12 <1 I 0" 6" 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 5.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERf OR ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: CO f GREJ' :R ANCHORAGE AREA BOR' ,GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS PHONE LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER~/~¢k -~'g('MATERIAL / NUMBEB OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH __ LIQUID CAPACITY/~2OO GALLONS, SEEPAGE Pit: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION__ DIAMETER OR WIDTH /~, CRIB SIZE: DIAMETER NEAREST LOT LINE __ / DEPTH DISTANCE FROM: WELL / -~- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~:~gY/.'g~' SQ. FT, ADD,TIONAL ABSORPTION ~'' JV'~:'~;h .,),'.~.C ~"/'- ,.~--/-/" /"u2I'C'J"~ WELL: BUILDING NEAREST FOUNDATION SEWER LINE CONSTRUCTION NEAREST LOT LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: LOT SLOPE: REMARKS: Form No, EQ-O31 DIAGRAM OF SYSTEM ~A.B. ~ ,%GRE,I R ANCHORAGE AREA BOI GH 3330 C Street Anchorage, Alaska 99503 / INSPECTION REPO ~-~,,-_ LEGAL DESCRIPTION: LOCATION SEPTIC TANK~ DISTANCE : '" ~ .:~,~l MATERIAL ~g / NUMBER OF FROM WE LL/~ .... MANU FACTU RER ~/~ C/~ .... COMPARTMENTS INSIDE LENGTH ......... INSIDE WIDTH .LIQUID DEPTt4_____I-IQUID CAPACITY~]~;~o GALLONS. SEEPAGE PIT: NUMBER OF' PITS --~. LINING MATERIAL /~:~/~----- BUILDING FOUNDATION-- DIAMETER ____OR WIDTH /~, LENGTH / ~, DEPTH CRIB SIZE: OiAMETER__DEPTH_~/ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) NEAREST LOT LINE · WELL: TYPE %/I )'2~1¢ CONSTRUCTK} - BUll_DING NEAREST FOUNDATION ..... , LOT LINE DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM ........ CESSPOOL OTHER SOURCES- APPROVED ......... DISAPPROVED -- REMARKS__ DISTANCES:. DIAGRAM OF SYSTEM INS1 ALLED BY, - ~ I C~ , "' 1. %~/~'~"~. I z~ .~.,.-:e./ J w;,~ ~( l ~. ,, "- ':~ ',,~3 ..... ',.-:,i~ ..... 7~ ~/* ~ ~ ~' . , I PIPE MATERIAl-: ¢~/~ Q~?/ GReaTEr ANChOrAge ArEa BOROUgh DEPARTMENT OF' ENVIRONMENTAL QUALITY 3330 'C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH ~ ~EEPAGE PIT ~ BOIL TEST RESULTS COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE RE{~UIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL GUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTB / DIAGRAM OF ~Y~TEM WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD SePTiC TANK, ///~ SEEPAGE PIT //~ ~:~ ., DRAIN field TO RIVER, LAKE, STREAM. CAST IRON ]NTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET iNTO UNDISTURBED SOIL. 4 iNCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF~NCHOR~-~GREATER ANCHOR - REA DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAiD CODE, DATE APPLICANT'S SIGNATURE BOROUGH ORDINANCE NO. 28-E8 AND THAT THE ABOVE EATER ANCHORAGE AREA BOROUGH ~ent of Environmental Ouali*v 3330 "C" Street Anchorage~ Alaska 99503 " ~ '- i , ~ med Performed for .__~,~_~-~~[id~ ,~.v,F Da~t.~er~or . . ')'h~s fo~ reports: Soils ~og ~ . ~ruu~n Depth Feet 1-: 3- 5- 6- 7- 8- g- in - 11- 14- Was ground water encountered? Reading 'Date GroSs Time If yes. at what depth? ~ 4. Time Depth to H£O Net Drop m'~ nu re. Pro~osed installation: Seepage Pit Drain Field Den~h of Inlet . Lle~{~~m of pit or 'trench ~ Date] w o am N co Q I TA tit ON 5 ° l4 � X41 `r41 'n cn 49 IL J � rl cra ct t� tt E- MW j ia w t�ilO�0 15 U ®� ��g C9 �?- �Juwiggzca wfx z,<a. p�p o�Wfl :U - w aWw Z 120 0 COR Gcl)��;a. ��o tw wQ � �19 f5 z 03 w®���-cwaZ W- © \tU� �clw i Q ,�, MUNICIPALITY OF ANCHORM5 i III Development Services Department"; Phone: 907-343-7904 On -Site Water & Wastewater Section \ Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-231-54 Legal description T15N R1 W SEC 18 LT 155 E PTN Site address 19444 BEVERLY AVE Chugiak AK Current property owner(s) RICHARDSON Expiration Date: 6/25/2025 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: 7/31 /2024 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 Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-231-54 Complete legal description T 15 N R 1 W SEC 18 Lot 155 E PTN Location (site address) , 19444 Beverly Ave, Chugiak, AK 99567 Current property owner(s) Georgina Shaday Richardson 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: A Private Well R Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units Fj Community Well or Public W Water Storage 4. TYPE OF WASTEWATER DISPOSAL: no Private Septic n Private Septic serving 2 dwelling units F-1 Holding Tank F] Community Septic or Public Sewer 5. SEPTIC TANK: F] Steel nN Plastic 0 Concrete n Fiberglass Age 4yrs - See advisory if steel older than 20 years 6. ABSORPTION FIELD: R AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench F Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: 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 $ Waiver Fee $ Date of Payment -Z 4 2--o Z_ y Date of Payment COSA # 2- Ll t 2- 45- Waiver # COSA Application —June 2022 COSA Checklist Legal Description: T15N R1 W SEC 18 Lot 155 E PTN Parcel ID: 051-231-54 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Well production at time of test 1.26 gpm Date drilled 9126/22 Total depth 145 ft Water storage tank volume 800* gallons Cased to 43 ft Well disinfected for coliform test? ❑ Yes AM Nc 0 Sanitary seal is functioning correctly 0 Coliform bacteria is Negative 0 Wires are properly protected Nitrate mg/L Nitrate less than MRL (ND) Casing height (above ground) 18+ in. Arsenic ug/L 0 Arsenic less than MRL (ND) Date of flow test for COSA 7/10/24 Collected by Forge Engineering Static water level at beginning of test 19.7 ft. Date 6/25/24 Comments *Multiple tanks. Not all tanks are easily accessible for inspection B. TANK DATA Measured operating fluid level in septic tank Date of pumping 6/25/24 JR's ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 11 /6/19 0 ALL standpipes present per record drawing Total measured depth from grade 6•5 ft (max) Measured depth to pipe invert from grade 6.0 ft (min) ❑ NIA — pressurized field. ❑ Per record drawings, field is insulated. 0 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 N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficienci C. LIFT STATION 7oflift maintenance completed tion years aterial Adequacy test date 6/25/24 Results Q Pass Fluid depth prior to test _ Water added 521 gal New fluid depth 0 in Elapsed time 91 min Final fluid depth 0 it 0 in Absorption rate '450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Qi Yes if No ft ] Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100' F' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft ❑o Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' n Yes if No ft Q 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' 0 Yes if No ft Surface Water > 100' M Yes if No ft Tank to Property Line > 5' ❑i Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' M Yes if No ft Private Wells > 100' r8_1 Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' E 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 Forge Engineering Engineer's Printed Name COSA Checklist —June 2022 Benjamin Schiller, P.E. Phone Date (907) 522-7773 6/26/24 A4, k� 49 Benjarr'nSchiller 12592 ���iFaPROFES51t1�4.~� 5f4a 907 Water Well Services "We Keep Alaska's Water Flowing" 907-230-1868 A 4 hour water well flow test was conducted at 19444 Beverly Ave Chugiak Alaska 99567 (T15N R1W SEC18 LT155 E PTN) on 7/10/2024 results are as follow. Total depth 145' SWL 18.5' Average combined well production 1.26 gpm If there are any further questions or needs, feel free to contact us at 907-230-1868 or 907waterwellsCv(,rnail.coin John Netherton /0 �i J W `= 0 Vj O]54) i 20Q4) cr ZO QN r: L s j � J r J c,7 z� Q�vi F-- O ¢ Z S Z O z U a W U wwow o �w-a o 0 = o wcawo � o z w 'o z o z z x ~o > w w o ao J Fc O UJ(D 0-,=,-c]zQa w�`oo� ooQ m a caw CL a z w Q ¢ ¢ LLzooz>z7.� w � � ow ¢ o w a wz�oatior zwC)Tzwo O m w O O w z W 1-Z O mO w z � Z z W LLJ � 4 ti�ozwQzon a MUHMPA- L0ry OF HCHORAG;m Development Services Department_ Phone: 907-343-7904 On -Site Water & Wastewater Section -- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-231-54 Expiration Date: /®^ `7- 2-0ZZ- 1. GENERAL INFORMATION Complete legal description T1 5N R1 W Section 18 Lot 155 E PTN Location (site address) 19444 Beverly Ave Current property owner(s) Paul & DOria Hastings Day phone (253) 569-3498 Mailing address 17634 SE 196th Drive, Renton, WA 98058 Real estate agent Christina Gamez 2. TYPE OF DWELLING: ❑s Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone (907) 865-6445 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑Q Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 550 Waiver Fee $ Date of Payment %�/ZZ Date of Payment Receipt Number. 0227q) Q Receipt Number COSA # 0 S Q 13 �,) (p Waiver # 5. 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 and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 6/30/22 401- � OF q X11 i �'•' TH 9+' /*:49TH •* 6. DSD SIGNATURE.. .... 4 . System #1 Approved for bedrooms Benjami„rvSchiller System #2 Approved for bedrooms rf�;��s�Fq. CE.12592 • �*���� Disapproved illi\PR��`I(0 - Conditional approval for bedrooms, with the following stipulations: ,?P0TY pF(0,� O y INH % A F ARS���m-= ) FRVICES,*,) � )�,%%NN z� By: Original Certificate Date: .7- 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory_ Other COSA Checklist blue sheet • Legal Description: T15 R1 W Section 18 Lot 155 E PTN Parcel ID: 051-231-54 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 0.5 gpm Date drilled 1974 Water storage tank volume 500** gallons Total depth '68* ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to UKN ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L On Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic u /L g ❑Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by Forge Engineering Date of flow test for COSA 6/29/22 Date of Sample 6/15/22 Static water level at beginning of test 54.8 ft. Comments *Max draw down on tests in file **Water storage information was provided but not inspected B. TANK DATA Age of tank(s) 2 years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank 50 NO Standpipes/foundation cleanout per record drawing Date of pumping 7/5/22 JR's D. ABSORPTION FIELD DATA Which system tested (date installed) 11/6/19 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.5 ft (max) Measured depth to pipe invert from grade 6.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION uired maintenance completed Age of lift st years Lift station material Comments: Adequacy test date 6/29/22 Results M Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600 081 New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '450 and Any rejuvenation treatment (past 12 months) N/A If yes, enter date NIA E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No ft Water Main > 10' Animal Containment > 50' Q Yes if No ft Q Yes if No ft Q Yes if No ft Water Service Line > 10' Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' []✓ Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. . Benja chiller ��j�F� •.. CE 12592 T /�1F9• . , 6/30/22 � • F��', kk�F, PROFESSIO .� COSA Checklist yellow sheet Municipality of Anchorage rE:L Development Services Department _ Building Safety Division F , YW On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC221326 During a recent COSA on-site inspection and test of the potable water supply well on T15N T1 W Sec 18 lot 155PTN, the well's productivity was determined to be .5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. G h V • Municipality of Anchorage °T On -Site Water and Wastewater Program (907) 343-7904 Parcel I.D. 051-231-54 Certificate of On -Site Systems Approval Expiration Date:10-20 72026 1. GENERAL INFORMATION: _ Complete legal description T15N, R1W, SECTION 18; LOT 155 E PTN Location (site address) 19444 BEVERLY AVE. CHUGIAK AK 99567 Current Property owner(s) ANNA NOWAK Day phone 350-1630 Mailing address 19444 BEVERLY AVE. CHUGIAK AK 99567 Real Estate Agent DAR WALDEN TEAM Day phone 865-6406 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ El Community ❑ ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ d I b' Waiver Fee $ Date of Payment Receipt Number Ocfg 451 G COSA # d Se a 0-13 12' 1 Date of Payment Receipt Number Waiver # -� 5. 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 and/or 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE 49— System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the #AECC884 0F i(AlyCy pN SIT FIp � WATER A �g 9m stip�l�1i\'.AAER 1) —,Vi OULl- Original Certificate Date: `7- 2_0 Zd The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc M-41 -t<.. • � �, .fir / . tr .4 1 5 o CE=O J 0�_ #AECC884 0F i(AlyCy pN SIT FIp � WATER A �g 9m stip�l�1i\'.AAER 1) —,Vi OULl- Original Certificate Date: `7- 2_0 Zd The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc M-41 Legal Description: T15N, R1 W, SECTION 18; LOT 155 E PTN If more than 1 septic system on lot: COSA Checklist # 1 of 1 Parcel ID: 051-231-54 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 0.15 gpm Date drilled 1974 Water storage tank volume **500 gallons Total depth *UNK ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to *UNK ft R Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L Arsen�c less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG,LTD. Date of flow test for COSA 7/2/20 Date of Sample 7/6/20 Static water level at beginning of test 25.3 ft. Comments *MAX DRAW DOWN ON WELL ON PUMP WAS 68.9' BTC - AT PUMP "300 GALLONS OF STORAGE TANK FOUND ON 7/2/2020. WELL PRODUCTION FOUND TO BEAT 0.15 GPM. OWNER HAD 2 - ADDTIONAL 100 GALLONS TANK ADDED TO STORAGE SYSTEM TO EQUAL 500 GALLONS TOTAL. GEG LTD. DID NOT EVALUATE WATER STORAGE SYSTEM B. TANK DATA .LIFT STATION / Age of tank(S) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA BED DRAINFIELD Which system tested (date installed) ""-611 9 ❑ ALL standpipes present per record drawing Total measured depth from grade 7.6 ft (max) Measured depth to pipe invert from grade 6.2 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: "DRAINFIELD MTS DRY ON 7/2/20 COSA Checklist yellow sheet ❑ Requir aintenance corn Age of lift station ye Lift station material Comments: Adequacy test date NEW Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test NEW in Water added NEW gal New depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date r°s ` ^ 1. l E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' QQ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' [D Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft ✓V Yes if No ft Yes if No ft Water Service Line > 10' M Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' M✓ Yes if No ft ✓� Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' QQ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' jv Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' ✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that 1 have determined through field inspections and review 0� of Municipal records that the above systems are in conformance with C� AT, MOA COSA guidelines in effect on this date. �.._.... Vol'• %f �y A.�6aaressQvj%0�_ 0, C O COSA Checklist yellow sheet �a °� o f e s sion�o� #AECC884 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage; AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 201321 During a recent COSA on-site inspection and test of the potable water supply well on Block T15N R1 W Sec 18, Lot 155 the well's productivity was determined to be .15 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval.