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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 1 LT 1Meadow Ridge Estates Block 1 Lot 1 #051-461-03 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201488 PID Number: 051-461-03 Dwelling: OR Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name Karen P Rush ABSORPTION FIELD El Deep Trench El Wide Trench El Bed El Mound Site Address 21132 Meadow Lake Dr ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-575-1366 3 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Meadow Ridge Estates 1 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 Ft2 Ft. Well >100' N/A N/A N/A >25- TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer Tank 1000 Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >10� N/A N/A N/A LIFT STATION Capacity Gal. .Manufacturer Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer JRs Septic Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspdecct sn 15, 5/7/21 Location and description 2 4h Bottom of siding @ west corner of house 3`d ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �.,. •' • ` .+,� 49 TH � .�,�..,.. r°ter• � F � • �F. Benjamin 2592i11er •�� �'srF 6/2/21 Septic System `7to Approved tr����' Date �20� �G. �, PROFESSIO��'� � Note: this approval does not include well permit requirements. . (Rev 05/02/18) // MH 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP201488 PID # 051-461-03 MEADOW RIDGE ESTATES, BLOCK 1, LOT 1 A B MH 12.1 SV 16.1 2CO 17.7 A B 32.7 34.4 33.2 FEET 0 50 100 10' UTILITY EASEMENT 20' SEWER EASEMENTSHED 10' UTILITY EASEMENTMEADOW LAKE DRIVETHREE BEDROOM HOME DECOMMISSION EXISTING SEPTIC TANK PER U.P.C. EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. 1,000 GALLON SEPTIC TANK w/20" MANWAY OLD TANK REMOVED & DISPOSED OF PER CODE SV2CO 6/3/21 PLAN AS-BUILT LOCATION OF WATER LINE MARKED & CONFIRMED AT CONSTRUCTION PROFILE AS-BUILT (NO SCALE) 97.7 93.4 98.3 104.7FCOMH SVPERMIT # OSP201488 PID # 051-461-03 MEADOW RIDGE ESTATES, BLOCK 1, LOT 1 1000-GAL SEPTIC TANK 2CO97.6 6/2/21 11.23.20 MUNIMPALITY Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION G Parcel I.D. 051-461-03 .. Property owner(s) Karen P. Ruth Day phone 907-575-1366 Mailing address P.O. Box 672371 Chugiak, AK 99567 Site address 21132 Meadow Lake Dr Legal description (Sub'd., Block & Lot) Meadow Ridge Estates, Block 1, Lot 1 Legal description (Township, Range & Section) Lot Size 26,510 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X Upgrade (w/wo AD U) Q Duplex (D) El Renewal ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ 2 Water Storage ❑' THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment 2 ?.O o Receipt Number: C S to dli� Permit No. CS P a d 1 W� R Permit App_::- : ._..:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) November 21, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Meadow Ridge Estates, Block 1, Lot 1 – 21132 Meadow Lake Drive Septic System Design Dear On-Site Services Engineer: The septic tank on the subject property has passed its useful life and must be replaced. We are submitting this application for a permit to construct a new septic tank. The attached site plan identifies the location of the home and the proposed and existing septic tank sites. No conflicts exist between this proposed tank location and any other well or septic system, whether on this lot or adjacent lots. The new septic tank will be placed near the same location as the existing tank. Storm water drainage will not impact this site. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption trench. No surface water is within 100’. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 11/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201488, Rebecca Carroll, 11/23/20 // MH 1"=50' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM NO EXISTING WELLS - PROPERTIES ARE ON A COMMUNITY WATER SYSTEM. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MEADOW RIDGE ESTATES, BLOCK 1, LOT 1 11/20/20 FEET 0 50 100 10' UTILITY EASEMENT 20' S E W E R EASEMENTSHED 10' UTILITY EASEMENTM E A D O W L A K E DRIVETHREE BEDROOM HOME DECOMMISSION EXISTING SEPTIC TANK PER U.P.C. EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. PLACE NEW 1,000 GALLON SEPTIC TANK w/20" MANWAY.SV 2CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201488, Rebecca Carroll, 11/23/20 MUNICIPALITY OF ANCHORAGE i 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 NAME PHONE ,�/'f—�/', NEW �OIQ �t5Y1rs Y'G::Tr�4'I � ❑UPGRADE MAILING ADDRESS Po R ox a i'uo'7MY;77 LEGAL DESCRIPTION L e;r l f LOCATION ` NO. OF BEDROOMS 3 Well DISTANCE TO: N A Absorption area 1 Dwelling / 6 PERMIT NO. U� J- h Z Manufacturer r 4.W K Material �,��� No. of compartments A- a.< .� ti�A OP!«e e (n Liq. capacity in gallons 000 IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. JUZ 02< Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well Foundation, 'l 1�H Nearest lot line PERMIT NO. w x J a Z No. of lines Length of each line, Total length of lines Trench width Distance between lines z w Fja ' G' b' 3 inches Q b Top of tile to finish Material beneath Total grade p tile effegtv�abrption area d��.• W04PPs CC77 Length Width Depth PERMIT NO. w C7 Q F- Type of crib Crib diameter Crib depth Total effective absorption area W a w W DISTANCE T0: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line IT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank jAb ption area ls) OTHER PIPE MATERIALS n SOI L TEST RATI NG ---- -- - - - - - - 7 y�C� INSTALLER y� 67-we)[c� r �-nastrwe 1 l0 ✓1 REMARKS 10P4 1 i' Tim to_Xrpt /� e ,a �9• . war - „� t k4 �. CE 5035 tt lU �FOF SSIOFI���ry 4S k ri i d A, APPROVED DATE LEGAL b ��- 1 �iK , e ��L i- cti ru res .2 72-013 (Rev. 3/78) ��F�h 1C., V-,-) ���/,���0 �EPHRTMENT HEALTH HND ENVIRONMENTHL OTECTION ' 825 /L/ STREET, HNCHORHGE, Al--'. 99501 ~� � 264-4720 CH VA ---E-3 JE-�E-7- E 9 A F:_4 F:-` RK -11 T~- .(MIT NO. ( 8]014] ) /PPLICHNT GEOLHR CONST PO BOX 13,02 ER. 99577 688-9400 LOCHT1ON LEGHL L1B1 MEHDOWRIDGE ESTATES LOT SIZE 999999 SQUHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MR-.-IMUM OF BEf"IROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: K`_a E-_ II`:! -u :',D ���Clip' 1"' 0 1:== �* 7-" CD FR, F-1 %.-� IE-- H.- ����R-A= �11_ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. E-':ETWEEN THE OuTFHLL PIP� AND THE 8OTTOM OF THE EXCAVATION (11.1 FEET). ����� �������I� ����� ��2E c��� J_ 92 ���������� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLL8TION INSPECTIONS OF ANY WELLS HI":lJHCENT TO THIS PROPERTY THE NUMBER OF RESIDENCES THAI- THE WELL WILL SERVE. RD ��� ������������� ����� ����������� __~ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION RND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TC) PROSECLITION. MINIMUM DISTHNCE BETWEEN R WELL AND FIN' -f' ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRI -,HTE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS AND CONSTRUCTION DIHGRRMS HRE HVHILHBLE TO INSURE PROPER INSTALLATION. 1 7, ����I F" EE " C. F- A_, J- 0_=h��� I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR SEWERS AND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED ISSUED B DHTE_ V40 is SOILS LOG MUNICIPALITY OF ANCHORAGE o DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION , 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: X'- N l'i o /J ! ,rrJ t//( J E- :' DATE PERFORMED: LEGAL DESCRIPTION: C>! 1.66,K' / E C>LjCG C'-CiTA -� FEAT SLOPE SITE PLAN z CI' 3 4- 5- 6- 7 56-7 �- �_ 8 9 U` 10 is 11 12 13 14- 15 16 17 18- 19 20 Ck/J vc C S C. iA7fr7 M � xVE'C5 WAS GROUND WATER S ENCOUNTERED?L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time®19 Depjh to Net - r��i� Drop Tll* 040 (✓ oo�s� "y F,! ft...`d a ° Zed ®® °n Goo- a a y�og ve�"G•o o °'a o�� 'w • C I. • ' No. CE -53 5 e e% Q oB•oo ooa• � ROFESSv30 � L --J PERCOLATION RATE✓(minutes/inch) TEST RUN BETWEEN FT AND _ FT �D COMMENTS /_JcfPTN 01CASnoy - Al dFEPc-,E' TiSN.P/f r'/r/JP'FEF7 PERFORMED BY: LLC,P q�l �/CI,Pn'�(i',tiCERTIFIED BY: �"� ' ',�• "i' ,rV J" k'',t'S�r-,c DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251169 Parcel ID 051 -461-03 Expiration Date: Legal description MEADOW RIDGE ESTATES BLK 1 LT 1 Site address 21132 MEADOW LAKE DR Current property owner(s) BURDEN ANTHONY W X The On-site system(s) is/are approved for 3 bedrooms M 5/6/2026 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date 5/14/2025 Thi3-Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject systefn(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE _��wNNOMMONNOM 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. 051-461-03 Complete legal description MEADOW RIDGE ESTATES BLOCK 1, LOT 1 Location (site address) 21132 MEADOW LAKE DRIVE, CHUGIAK, AK 99567 Current property owner(s) ANTHONY W BURDEN Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: E] Private Well serving # dwelling units F-1 Other Non-public well as regulated by MOA El Water Storage ON Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: FX Private Septic ❑ Private Septic serving 2 dwelling units F Holding Tank F1 Community Septic or Public Sewer 5. SEPTIC TANK: F-1 Steel RE Plastic F-1 Concrete R Fiberglass Age 4 _ See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: F] AWWTS E] Bed RN Deep Trench ❑ Wide Trench ❑ 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 ov Waiver Fee $ Date of Payment' 1131a Date of Payment COSA # OWA IIL6 Waiver # COSA Application—Apr2025.doc COSA Checklist.docx COSA Checklist Legal Description: MEADOW RIDGE ESTATES BLOCK 1 LOT 1 Parcel ID: 051-461-03 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 5/6/25 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 4/12/1983 ALL standpipes present per record drawing Total measured depth from grade 7.9 ft (max) Measured depth to pipe invert from grade 4.1 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 3.8' Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/6/25 Results Pass Fluid depth prior to test 4 in Water added 450 gal New fluid depth 18 in Elapsed time 1440 min Final fluid depth 4 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 6 in (Missing ED + Final Fluid Depth) Effective depth remaining 42 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 2” of ED is missing / not measurable. Measured & tested through the southern MT/SUMP. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *7.5 ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS Waiver #131434 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 5/14/2025 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 & 5/14/25 MUNICIPALITY OF ANCHORAGE US H Development Services Departmlent Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-461-03 Certificate of On -Site Systems Approval 11 Id �o�2 —fft\C—. 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date Meadow Ridge Estates, Block 1, Lot 1 21132 Meadow Lake Drive Chugiak, AK Current property owner(s) Mailing address Real estate agent Karen Ruth P.O. Box 672371 Brandi Sullivan Day phone Chugiak, AK 99567 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 575-1366 (907) 232-9504 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑n Water Storage ❑ Holding Tank ❑ Community Well FE -1 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ S77, 5D Go l/ 1 o Date of Payment i I' Z5lob ZO Receipt Number OG F (oyib COSA # (_DSG 20 16 5(; Waiver Fee $ 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. 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 Michael E. Anderson, P.E. 6. DSD SIGNATURE Date 11/24/20 ®®®.w®®'a8>me , Of q m ` 49th System #1 Approved for � bedrooms %A" WCHAEL�E. ANDERSON ' 00, ;S, No. CE -4381 •' System #2 Approved for bedrooms e®+�F;••.,,.11/24/20 Disapproved ®® 4o4®a0®ES5\�o+®®®® Conditional approval for 3 bedrooms, with the following stipulations: LxW a r y e�, U!�� cc -� 7164202 1 _ J ON-SITE c NIP 7 Pei VV#`lER =—!a WASTE:v�'ATER z — 4 j� PROGRAM ,�1'CC` 0)))1)))))ll�`�' ►�^ ` Original Certificate Date: 2-4--2 (? 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 COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: 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) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade 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 Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Meadow Ridge Estates, Block 1, Lot 1 051-461-03 Class A Community Well - PWSID #210401 <1 SEPTIC/PLASTIC N/A New construction Deep Trench 4/12/83 11/10/20 3 9.2 0 5.2 518 16 1440 0 >450 ✔ COSA Checklist yellow sheet 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’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I 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. 7/2/21 - Class A Well Serves Subdivision. ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 7.5* ✔ ✔ See waiver #131434 c -0 -1 m 83882 Z r �> cn Cf) ym� D ~ 1,M -i m Om=z r ��t, e` I z 0 cn m =O .. 47 m�*0 -Q z -n o TI) o Fn o z m � CD��.j • m --i 0 � o 0 c� zzm2 0 O °Qn® O ® - CD -s i-MT��.� omn0 ��CD . 00= CD 0 z�m n. CCD I m; 0 \ ® _Co \ > \ \ z --.& W =cn I 33 -n -n -n z C7 � 4�' \ 1 W Co 0 �- o \ LS' \\ I Q O \ \ �1` Iro CD C)� �• :3 CD p O O \ �� n `� _CD CD a CD C31 CD CD ® N I c Dr^ CD �' O ® (n I V O CD � n ``®�® TB _ N 0�cJ3� .} ' f fl3 1l mIV —1.. . C) S a D 0 -Sys T I� o O A S '" - AWCL 3 CD o • N• • • • CD CD P'' CD I (� CD o o / ,, 00 CD moi! ® �� CD CD 3 O • ® r+- . e-+- 0SCD � • O M CD � n .zy- co U? =a° Q � CD M I Cy cD �- �. �tiJr �, ©fie •'4 c00 00 CD '6� /r n ® - o o -o I ® I CD C: 4�s v 3.7 ov=m( Qi ��0 4,CD a z CD Cc 3 o .tv ` 6'O O < I r --I- �9cr ^ Q I O O rn �--s(n� I novo �.-- •_; ,<;;°~ o�,� CD —=570 :5�vvto '> 33 ���cDsv C)o�r*on�®���'.n0 ®Q \ J CD (D cn N m 3 CD O 0< O ❑ 0 a- CD m o 0 -0 3 � � > ch -- cD CD � -a � M ��O 7L 0 3 C� m m O N ®� C /lA Vit' �� �,• < "< ®CD ® CD co" cn CO, ``� :- "��`,Q 44 �� I 0 CD -o E� a- G) :5 =r 0) m DO C)� C— N �; O N o w O CD �+ �0 :3' rn >— �� �tJ `V 4 'e > cn � � m MO < O OCD ® .n � ��®���mCoCO aa0®nm�.0 C) cn cn r., =3 0 O cn' CD C �' CD D CD N 0 rn O.. "� ili C3� I � [� cnCf) 03 coffin a- CD D — -I CD :3 r- cnC/)C/� o- Cn to �N cn ay O CD C/) Ocn cQ_��-o Q� 0- p'�•cn co �� C nO v m CD -a CD @ cr N `< _ CD > N CA CD - CD @ L D iU C/) \ i U) O �+ cj o tV a -s CD "l �CD 0. O .-+ O CD ❑ rn O N O M O= -CD 5. e � p 0. C Cr n W CD CD 0 COctt CII �- m < CQ (n O -� << Cn C —1 0- :3 mCD 00 CD 9L0 Q �. cn _ Oco r 00 N December 2, 2020 MOA Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Meadow Ridge Estates, Block 1, Lot 1— 21132 Meadow Lake Drive Conditional COSA Dear On -Site Services Engineer: The owner of the subject lot is in the process of selling the home. Unfortunately, the septic tank on the property has passed its useful life and must be replaced to meet current Municipal Code. A permit has been obtained to replace the tank, but the work can't be completed until early next Spring. We are therefore requesting a Conditional COSA be issued to allow the transfer of the property to the new owner. Sufficient fiends will be escrowed to compensate for all costs associated with the tank replacement. The existing septic tank is more than 37 years old but does not appear to be in imminent danger of catastrophic failure. In our opinion the septic tank will function satisfactorily until it can be replaced in the Spring. There is no threat at this time to the health and safety of the property or the public in general. Sincerely, P�T. �F .......Ar .` ?9th ° MICHAEL E. ANDERSON ? t •6 No. CE -4381 .' �'F�°•• 12/2/20,,••''��' Michael E. Anderson, P.E. Parcel I.D. 051-461-03 Rt64^ 8Ui Municipality of Anchorage g On -Site Water and Wastewater Program o (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 6 - I 1. GENERAL INFORMATION Complete legal description Meadow Ridge Est. Block 1, Lot 1 Location (site address) 21132 Meadow Lake Drive Current Property owner(s) Don & Consuelo Bauermeister Dav phone Mailing address PO Box 773401 Eagle River, AK 99577 Real Estate Agent 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class 'N Well Community ❑ Public Water System ❑ Public Scaler ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Ljq d , t� Waiver Fee $ /V /bIrg !1 J Date of Payment 16. 3 Date of Payment Receipt Number a31 &0&:;;l Receipt Number O lU l COSA# 0 e,1 JiS�V 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD /SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for _ bedrooms Disapproved Date 6/21/13 Conditional approval for bedrooms, with the following stipulations: By: ! /L�:�/�%Y1,K�T Original Certificate Date: if- i The nic' - i o chorage 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet C'. )., c If more than 1 septic system is on the lot: COSA Checklist # of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Meadow Ridge Est. Block 1, Lot 1 Parcel ID: 051-461-03 A. WELL DATA Well type Class 'A' If A, B, or C provide PWSID # 210401 Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height Aweground) in. FROM WELL LOG AT ECTION Date of test Static water level ft Well production g,p,m, g.p.m. WATER SAMPLE RES S: Coliform colonies/100 mL Nitrate mg/L ArSerfic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Collected by: Date installed 4/12/83 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping k/�1c> // 3 Pumper :TA r ; r pU. r p , ,-. fy C. ABSORPTION FIELD DATA Date installed 4/12/83 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SF/BR System type Deep Trench Length 60 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth 9.3 ft. Eff. absorption area 480 ft Monitoring tube Y Depression over field N Date of adequacy test 6/18/13 Results Pass/Fail PASS 3 ( ) For bedrooms Fluid depth in absorption field before test 4 in. Water added 493 gal. New depth 6 in. Elapsed Time: 120 min. Final fluid depth 4 in. Absorption rate , 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "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 WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation r Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundafion"w 715 Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage11 0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS AS SNoW/y OA-; -�SPae--170.0 SER -0 -2 Ciz.ALVI 5-PAca-0174 Q0-CVzd— G. ENGINEER'S CERTIFICATION I certify that f 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. Engineer's Printed Name Steven R. Pannone Date 6/21/13 COSA brown sheet -1 0-10-1 2.doc Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program Al`�, do �, QL n Department **** VARIANCE/WAIVER REVIEW **** Waiver#: 131434 PID#: 051-461-03 COSA#:131521 Permit#: Legal Description: Meadow Ridge Est. B-1 L-1 Engineer: PES Applicant: Don & Consuelo Bauermeister Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 7.5 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer ............................................................................... Rec#: Amount: Date Paid: **** VARIANCE/WAIVER REVIEW **** �t= Anchorage Recording Precinct, Alaska, and that the ,�, m°s '.i` noenis situated thereon are within the p hues and do not overlap ar encroach on the 1 there e. v property g adjacent - to, that noimprovementson property lying adjacent thereto encroach on a in premises questioa and that there are no roadways, trsw mission lines or other visible easements on said property except as indicated hereon. 1 Dated at Eagle River, Alaska i ��[ ti,3z 11 . dR'$ ni P' l i6f%' ''' ROBERT C, JOHNSONG,,+--- 14 V 4O. ~•`O,� , f PJ � , 1 ,.s I hereby certify that I have surveyed the following described property: +'• Anchorage Recording Precinct, Alaska, and that the ,�, m°s '.i` noenis situated thereon are within the p hues and do not overlap ar encroach on the 1 there e. v property g adjacent - to, that noimprovementson property lying adjacent thereto encroach on a in premises questioa and that there are no roadways, trsw mission lines or other visible easements on said property except as indicated hereon. 1 Dated at Eagle River, Alaska "• ��[ ti,3z 11 . dR'$ ni P' l i6f%' ''' ROBERT C, JOHNSONG,,+--- f >" SCALE: Registered Land Surveyor No. 880 -LS -.. V =40' Box 498, Eagle River, Alaska Time APPLI( Ni PILLS OUT UPPER HAI ONLY Time Property Owner --� -� /-`•'ty :'/i% _ ;7�) r_.:} //) Phone Mailing Address-�,[J,j?,-OX _ j/I -`- `"1-/. 4% �' , Zip Code Date Buyer s-sj �J;:''.J `_ a C _. ...v •. I., - Date, -- Address Zip Code Inspector Lending Institution -' 4-/,-17-;Jit/%}L /,;ii7!,"�,- Phone MUNI DEPT. OF H°i`.LTH ". ENVIRONMEVTAI. PROI ECHON ✓ MAY A7 RECEIV Ea Address Zip Code ( ) DISAPPROVED Realty Co. & Agent (1> ."<i);�l�' Phone Addressi) r'>r�k 'J/( :;.�;.. y,Fyi,,.;, J��,,-. Zip Code _- i 'i-- ,-. � Legal Description Well To Absorption Area Well to Tank Well Log Received Street Location Type of Residence Ki Single Family Multiple Family No. of Bedrooms ❑ Other Water Supply . ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [�: Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Individual y Year Individual Installed: "/ l) •i Public Utility When Connected to Public Utility: n Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date, -- Inspector Inspector Inspector Inspector Field Notes: MUNI DEPT. OF H°i`.LTH ". ENVIRONMEVTAI. PROI ECHON ✓ MAY A7 RECEIV Ea ( PPROVED BEDROOMS 3 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL'' DATE 1r -- k3 BY: _ Soils Rating Date Se er Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size