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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
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►�^ ` 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
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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
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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
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'''
ROBERT C, JOHNSONG,,+---
14
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4O.
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1
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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
"•
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ROBERT C, JOHNSONG,,+---
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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