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Home My WebLink AboutMEADOW RIDGE ESTATES BLK 2 LT 3Onsite File Meadow Ridge Estates Block 2 Lot 3 #051-461-19 Municipality of Anchorage On-Site Water and Wastewater Section ° (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201060 PID Number: 051-461-19 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Patrick Domitrovich ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21045 Meadow Lake Dr ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907 390 0845 1 3 0.8 GPD/SF 9.54 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.87 Ft. Gravel depth beneath pipe 2.67 Ft. Subdivision Block Lot MEADOW RIDGE ESTATES 2 3 Fill added above original grade 0.5 Ft. Gravel length 30'+ 40' Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic I Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 564.5 F0 2 - 13 Ft. Well NA NA NA NA NA TANK X Septic [IS.T.E.P. F-1Holding [:1Other Manufacturer Anchorage (installed 2016) Capacity 1250 Gal. Surface Water I > 100' > 100' NA NA Material Number of compartments I Lot Line 1>10' > 10' NA NA NA steel 2 Foundation >10' >10' NA NA LIFT STATION Manufacturer Capacity / Remarks septic tank and 30' length x 32" ED Gal. trench constructed in 2016. Alam, location Electrical installed by Tank to PIPE MATERIAL House to tank D3034 drainfield D3034 Installer QRS Septic Drainfield D3034 CO/MTD3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspdection 1m 4/21/2020 4/24/2020 Location and description 2nd 3d 4/27/20i 4'h 4/29/20 side door threshhold ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date®P'�� Aek°v�d ti . °Curtis L d ' O �� Date 5 2nd; ��FC�p,F No. CE Septic System. Approved Date Date 5 (aD�U ��l �FDPROFESS10t�� Note.: this approval does not include well permit requirements. ��?� kRCV VV, VG, 10) NEIGHBORING SEPTIC IS 1' FROM PROPERTY Q / LINE, WR920075 2 � I 21% / 1' 1250 GAL SEPTIC / ypMR WATER LINE ENTERS I TAN INSTALLED 016: Cp$ E BM HOUSE AT THIS POINT 0' L x 5' W 32" 50/50 SPLITTER VALVE FENCH C H INS ALL CO 4 D TH RE \ ADDITIONAL 40' L x 5' W x /2016 0 C T \ 32" EFFECTIVE DEPTH / SHED.. TRENCH WAS CONSTRUCTED/ 2�% \APRIL 2020 T / CO3 3 30 1 FENCE j \ 10 40/ NEIGHBORING SEPTIC � IS>10'FROM / PROPERTY LINE SCOPE OF WORK 1. 1250 GALLON STEEL SEPTIC TANK INSTALLED 2016. 2. 30' L x 5' W x 32" EFFECTIVE DEPTH TRENCH INSTALLED 2016. 3. AN ADDITIONAL LENGTH OF 40' x 32" EFFECTIVE DEPTH TRENCH WAS CONSTRUCTED IN APRIL 2020. / / MAXIMUM DEPTH OF EXCAVATION WAS 10'. /THIS LOT AND ALL NEIGHBORING 4. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL / / LOTS ARE SERVED BY A REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL / COMMUNITY WATER SYSTEM AND CODE CHAPTERS 15.55 AND 15.65. i THERE ARE NO WELLS WITHIN 100' OF THE SEPTIC SYSTEM SWING TIES ON PAGE 2 Septic As Built Drawings Prepared for ...+� **�1k■ �mi ++ PATRICK DOMITROVICH �. 10,p�,...•••••••.��Qs�i*� 21045 Meadow Lake Dr Chugiak, Alaska 99567 �,.•� '' !# MEADOW RIDGE ESTATES BLOCK 2 LOT 39T-" : • 0SP201060 ;................ t ................:.....,0.............�......................• EK�UTNA ENGINEERING, LLC DATE: 5/8/2020 .CURTIS TOWN i 19162 MOUNTAIN ROAD DRAWN: CLT �� 0' No. E 1904 :ff CHUCIAK, ALASKA 99567 = ' •�1 •'fir,....... (907) 355-9820 PDA 051-461-79 SHEET 120F03 '+++��++••• H a z ORGANICS JOB SILTY SAND WITH �sm GRAVEL AND FRACTURED ROCK NEW 4D' x 5' x 32" �' LFFECTIVE DEPTH TRENCH INSTALLED 2020 MARK Z � - F- zF- F -0 _j _j �a 0 U U mz Z Zl¢iJF 33'-9" Q0 J aCJ 27'-4" ;s H 0 O J LL C) r n_ C��_� �_ —Q -C,- ,9�. H a z ORGANICS JOB SILTY SAND WITH �sm GRAVEL AND FRACTURED ROCK NEW 4D' x 5' x 32" �' LFFECTIVE DEPTH TRENCH INSTALLED 2020 MARK A B SV1 20'-5" 27'-1 " SV2 24'-2" 33'-9" CO1 27'-4" 39'-6" CO2 50'-4" 67'-2„ CO3 53'-0" 51'_0„ C04 32'-9" 22'-10" SWING TIE B TO OUTSIDE OF CANTILEVER EXISTING 30' x 5' x 32" EFFECTIVE DEPTH TRENCH INSTALLED 2016 Lci EXISTING 3D' x 5' x 32" EFFECTIVE DEPTH TRENCH INSTALLED 2016 AREA BETWEEN TRENCHES WAS EXCAVATED AND BACKFILLED AND COMPACTED ORGANICS SILTY SAND WITH GRAVEL AND FRACTURED ROCK GROUNDWATER WAS NOT PRESENT 4/13/2020 Septic As Built Drawings Prepared for ., PATRICK DOMITROVICH OF q�� , 21045 Meadow Lake Dr Chugiak, Alaska 99567 MEADOW RIDGE ESTATES BLOCK 2 LOT 3'. 49T" �= �0 OSP201060 ............ ... ........"""' "'"".. . .. ' EKLUTNA ENGINEERING, LLC ,�........... '�. S ................... ..' DATE: 5/11/2020 � CU TIS TOwNSEND;r 19162 MOUNTAIN ROAD DRAWN: CLT •�'��':,� No. C 11 04 CHUGIAK, ALASKA 99567SCALE: 1112" = 1' * + f . 14 �U•��"^"�"'�-�� (907) 355-9820 PID: 051-461-19 SHEET 3 OF 3 +� ,�� 0, �10' UTILITY EASEMENT Lot 2 00 635 ^h0 ry� 1.1'x1.4' CANT "C 3�Lot 3 ,8• 2.0'x26.2' CANT 28,489 S.F. / O iL .RETAINING 11 4.0'x12.2' WALLS DEC � \ DECK �b SEPTIC PIPES / a /.. O� `\ SHED" 5 J `CHAIN-LINK FENCE vA r / H 6.5'x6.7' SHED S�, ^ q 0 Lot 4 /' 0 ao V RETAINING WALL � 10' UTILITY EASEMENT / 0 / NOTE: LOT IS SERVED BY A COMMUNITY WATER SYSTEM. / PLOT PLAN ___ AS BUILT _x_ SCALE __1"_=4a-_ GRID _ NW 1362-- Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 00000p�� (907) 522-4625 Fax oF q X04 Professional Land Surveyors ken*langsurvey.com y jonothanAlangsurvey.com OpP gs04o I h `OTy3Certify BLOCKh2 (MEADOW surveyed E ESTATESfollowing SUBDIVISIONdescribed (PLAToNorn72-261) 0° 49?H �� Anchorage Recording District, Alaska, and that the improvements situated thereon are 0" ""' "' . . . . within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed �'�'KENNET.. . .. .....0 premises and that there are no roadways, transmission lines or other visible O��, % :• � easements on said property except as Indicated hereon. 'Lt'Y11J p Dated this the — Day Day of ___LLLI ` at Anchorage, Alaska 0�4�F�p 'LS -5 404RaFfS-- 202 SIONA� �o It is the responsibility of the owner to determine the existence of any easements, O40�0N00 covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201060 Work Type: Septic Upgrade Tax Code Number: 05146119000 Site Legal Address: MEADOW RIDGE ESTATES BLK 2 LT 3 G:1362 Site Mailing Address: 21045 MEADOW LAKE DR, Chugiak Owner: DOMITROVICH PATRICK F Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: q -2—Z — Z U �1»cnr .S: Ucpurtmcnt Effective Date: 4/17/2020 Expiration Date: 4/17/2021 Lot Size in Sq Ft: 28489 Total Bedrooms: 3 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 e3xe_O_Qa ; V�, US, bq-IWQeA 'Jo1 �0 +Te.taic_( -+- (\e0 eve b Z p ov�� m ac (dam Pu�)' ✓ C Lt) hozb Received By: Date: _ Issued By: jwaa. (�Uwv Date: y/17 1 0 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201060, Rebecca Carroll, 04/17/20 — Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIA 4C OSP201060, Rebecca Carroll, 04, 7/, NEIGHBORING SEPTIC / IS 1' FROM PROPERTY Z LINE, WR920075 hof 2 O 21% 3 / 3 1250 GAL SEPTICHpyE WATER LINE ENTERS TAN INSTALLED 016 .' .x L -4i COs HOUSE AT THIS POINT I0' L x 5' W 32" / 50/50 SPLITTER VALVE / 3 FFECTIVF D TH O 'TRENCH VINS ALL CO CONSTRUCT AN ADDITIONAL I 2016 % 5' _ 40' L x 5` W x 32" / / �. / SHED .. EFFECTIVE DEPTH TRENCH. / __k � / MT T� ��2 0, 30 r— FEN�E CO 1 AREA 30% OEa NEIGHBORING SEPTIC IS > 10' FROM / PROPERTY LINE SCOPE OF WORK Qj 1. 1250 GALLON STEEL SEPTIC TANK INSTALLED 2016 WITHOUT THE BENEFIT OF A PERMIT. 2. 30' L x 5' W x 32" EFFECTIVE DEPTH TRENCH � � INSTALLED 2016 WITHOUT THE BENEFIT OF A PERMIT. 3. BASED ON PERCOLATION TEST PERFORMED APRIL 2020, AN ADDITIONAL LENGTH OF 40' x 32" /THIS LOT AND ALL NEIGHBORING EFFECTIVE DEPTH TRENCH NEEDS TO BE / LOTS ARE SERVED BY A CONSTRUCTED. MAXIMUM DEPTH OF EXCAVATION TO / / COMMUNITY WATER SYSTEM AND BE 10'. r THERE ARE NO WELLS WITHIN 4. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH ALL 100' OF THE SEPTIC SYSTEM REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Septic Permit Drawings Prepered for PATRICK DOMITROVICH p. 4k .DF DF 44 kilt 21045 Meadow Lake Dr Chugiak, Alaska 99567 d 9°0� MEADOW RIDGE ESTATES BLOCK 2 LOT 3 `°�" �o OSP201060 �' ,..................... . a �..,. .............................*. ,0 EKL UTNA ENGINEERING, LLC DATE: 4/17/2020=;CURTIS TOWNSENDi �,� a DRAWN: CLT �d No. CE 11904 ::'��'AY 19162 MOUNTAIN ROAD 0 CHUGIAK, ALASKA 99567 (907) 35;;-9820 SCALE: 1" = 40' PID: 051-461-19 SHEET 1 OF Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201060, Rebecca Carroll, 04/17/20 Double foundation clean outs at the house foundation. Close up of double foundation cleanouts. Inlet line into septic tank. Tank was placed to avoid large rocks discovered while excavating. Upstream end of tank visible. Excavated hole where tank was placed. Tank was placed to avoid large rocks near foundation. 1250 gallon steel tank manufactured by Anchorage Tank is visible in the photo. Also visible is the septic rock that was placed in the new 30& wide trench. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAI LI NCzAD DR ESS LEGAL DESCRIPTION LOCATIO~ I DISTANCE TO: Absorption , ,.,. y __ J J¢~¢~ I IF HOMEMADE: Inside length Dwelling IWell DISTANCE TO: PHONE 8'? Dwelling MateriagT~, e W dth Manufacturer Length Type of crib Class DISTANCE TO: ' Well,/~ A No. of lines Length of each li0e Top o'f tilYto finish grade ~,~i'~ ~,~ 2i NO. OFBEDROOMS.~ PERMIT NO. No. of compartments Liquid depth Width PERMIT NO. Material Liquid capacity in gallons Foundation /'~ '~' Nearest lot line,~,.~,.~ PERMIT NO~ ~ Z~ Total. I.~engt~s Trench width · ~ inches Material beneath tile Depth inches Sewer line ~ NEW [] UPGRADI=- Distance between ,ine~ .~ Total effective absorp~To~ area PERMIT NO. Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Septic tank Absorption area(s) OTHER PIPE MATERIALS INSTALLER REMARKS Z' ¢lbll t ' ,,j ~ '~ - "~ ~ ' ' ~' ~ V APPROVED ~ p,0~ESSi0~y~ DATE LEGAL z r3 72-013 (Rev. 3/78) F'ERHIT' NO. DEPFII';TTHENT ~. I../I:~:FIL. TH FINE:, Ehl',,,' ~ RONI"tEI'.,tTFi[ OTECT I 01'.,I S25 "'1.. '" !~';TI?IZE:T., RNCHOI:.~'.FIGE.,F. II-:::. 9950:J. 2,5,4-472E'~ ':: Lz',}'--":Oq.d;Z"..':, I::iF'F'L ]: CFIt'.,I]" I::IL.L. F:ILJ::I:~;I.:::FIN [.:ILl :[ I....DEI';.:::;:; F:'O LO~F:IT]:Ed'-,I II",IiSTFIL. L ::L~Z~O'" I:'ROH H:[GH HFITER ON LFIk:E LEGFff... 1_3 ?,3 I"IEFIE:,Ckt,.IF.: l [:,Gl!.: [:Z:gTFITES LFFt" kq F::E: FI'frET ]"'gF'E AF %1- IL.. FIE::F.;ORF'TIEd'.,I .~,'~'.:,FEI'I .... IS · TF.':Ei'.,IE:FI :5OIL RI::IT:[I'.,II:i ':::~;Q t::'T,-."EIR)= ::LS,cZ~ I"/FIX]:HUH NI.JHBER OF E~E£:,F.:O0t"I~; ,:= 3 THE L_ENEi]"H [:,II"IEi'.,I$IOI'.4 IS THE: LENGTH ,.'ZII'.,I FE:ET::, OF THE TREI"4C:H 01;:: DRFIIt'-,II::'IEL[:,. THE [>EF'TH OF FI TRENE:H OR F'IT ]:?~ THE [:,I'.-Z, TFtNCE E:ETHEEN 'THE': '_-7, URFFIC:E OF THE GROUNI.-:, FIN[> THE BOTTOH OF' ]"HE IEXCFt',,,'FIT I O1",t ,:: l I",! FEET "I"HER[Z.. I:5 I'.,!0 L:.;IET klI[:,TH FOR TREi'.,IC:FIE:5. THE GI:4:I::I',,,'EL [:,EPTH 1' S THE I'1 :[ i'.,I I HIjH [:,EF'TFI OF' GF.:R",,'EL BEI'[,.IEEN '1'HE OU]"F'FILI_ F:'I I::'E I::lhtD THE E',O]'TOH OF THE EXCI::I'v'FI]"]:ON ,:; I1'.,I FEET::,. PEF::H I T FIPPL I CFtI'.,IT HI::IS THE RESF'Ed'.,I:51L:: I L I"F'.r' TO I NFOF:H TH 1:5 I::,EF'RF.:THEi'.,I"I~ [:,l...ll:~ ]: l'.,ll'3 THE ]: NE;'I'FILLI::t"I' ]: ON Ii'.,I:~I::'ECTILqI'.,t:.~; FF:' IZll'.,l'.r' I.,.IELL. 2; FIDJFICEI",IT 'TO "FHZ% FF:UJFEI:.-[~ FI~",I[::, THE NUHE:IZR OF' ,q'.E:~;:[[:'ENCEff; THFFF 'T'HE I.'.llEL. I... I.,.IILL.. :E;ER',,,'E':. E:RCI.:::I::iLLINC. i OF FtN'T' :q.,"r".E:;TEH HITHOU]" FII",IFIL IN2;F'IECTION Fli'.,ll::, HF'PF:.- -~ .... ,HI.. E:"r' 'THI:5 [:'EPFtRTME]",H- [4 ]; LL. ~.~:E '~";I_IE J'E: 'I" TO F'ROSECUT :[ ON. H II",tlI%IH [:'I:~.;TI::INCE E:E'I"!4EEI",I FI .[']ELL FIND FII",I"," r'II'.,I-SITE 2;EHFII3E I::,IE;F'iDSF~L E;"r'STEH ::I..(']E'~ FEET FOR FI F'RI',,,'FITIE [,.IELL. OR ±SE~ TO 2Eu.Z~ FEET FROH FI I:::'UE~LIC [,]lEl_[... DEF'EI",I[:,IIqG UPON 1"HE T","F'E nF PUE',LIC HELl._. H:[NIHUr,1 [:,t?.,TFINCE FROH FI F'F.'I',,,'F~TE HEL. L. TAR F'F.:I',/FITE :~';EI.,.IER L. IhlE I'.'.:; 25 FEET Ffi'.,II:> ']"0 I..-.I C:OHHL.INIT"r' '.:.;E[,.IER LINE I':L:; 75 FEET. OTHER I:~:'.EC!I...Itl;"..'EHEt'.,IT:5 I'"IF':t'T' F:IF'F'L.'T'. :SF'EC::IFICFI]"ION2"; FINE:, CCII",t'.'STRUCTIOI'.,I I)IFtIC]RFIHS FIRE I::I ',,,' FI I I_F:IE:L[:Z TO I I",IL-Z,I..IF.':E F'F.:OF'ER I I",I?.',TI::IL LR'T I L-IN. Z[ CER"I" l F:"T' THFIT :i.' :[ FIH F'I::IHIL.~FIR [,.II'I"H THE RE6:!UIF,::EH[:Zi'.,ITff; I':"E[R E[I'.,I-.-E;ITE ':7, EklEF.:2"; FINE:, ,t,.IELL. L:; Fl'.".".; '-'-";ET F'Cff~:TH B'T' THE HI_II",I:[CtPFIL. tl'"r' OF' FIi',IE:HEIRFtGE. :"~:: ): HILL. ZN:.".7, TRL. L THE :E;'9~.";TEH ]:1",1 F:ICCOF::DFII",ICE kI:t:TH THE 3' :i: UI",t[:'EI:~::STI::II",IE:' ]'HFIT THE Ed"4"'":~;TTE :'SE!-'.IEI;:": .'Sr'..~;TEH I'"lF:l"r' F.:EC!UIRE EI",ILFIF.:GEHENT IF ]"HE F.:EL'5, Z [:'ENE:E :[ ~:EI"IEff::'E'LE3EL "i"E~ INCL. LIDE HORE THRhl 3: BEE:'F.:OEd"/:5. fflI::'F'L. ICRHT FIL. L. FI[~I'~',LI):LE:ER:~.';'" -- PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST SLOPE WAS GROUND WATER ?Z'') 0 SL ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN . FT AND ~"/~T , -/~. ////// (minutes/inch) DATE/ 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 Parcel I.D. 051-461-19 1. GENERAL INFORMATION Expiration Date: ffAqdQ09 Complete legal description MEADOW RIDGE ESTATES BLK 2 LT 3 Location (site address) 21045 Meadow Lake Drive Chugiak AK 99567 Current property owner(s) PATRICK DOMITROVICH Day phone Mailing address 21045 Meadow Lake Drive Chugiak AK 99567 Real estate agent Ristine Casagranda 2. TYPE OF DWELLING: 0 Single Family ( wo ADU ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907)362-2299 3. NUMBER OF BEDROOMS: 3 i 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic [] Water Storage ❑ Holding Tank, ❑ Community Well ❑x Community 1 ❑ 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 $ go _ 0 16.00 Waiver Fee $ Date of Payment Sf l /go ;2d Date of Payment Receipt Number - () (?o�to40 - Receipt Number COSA #15 Waiver Waiver # COVID-19 ?5% DISCOUNT APPLIED i' 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* 6n 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 thetime of installation. i acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date 4/30/2020 6. DSD SIGNATURE y/ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: o. ®N -SITE • ER AN M WASTE oIA �-: PROCf,AM i By:- Original Certificate Date: 5 La 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. t 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: MEADOW RIDGE ESTATES BLK 2 LT 3 If more than 1 septic system on lot: COSA Checklist # of 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 } in. Date of flow or COSA St water level at beginning of test ft. Comments served by community well B. TANK DATA Age of tank(s) 4 years Tank type/material septic Steel Measured operating fluid level in septic tank 49, ■❑ Standpipes/foundation cleanout per record drawing Date of pumping 5May2020 D. ABSORPTION FIELD DATA Parcel ID: 051-461-19 Structure served by this system Well production at time st gpm Water Stora volume gallons W isinfected for coliform test? ❑ Yes ❑ Nc ❑ 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 C. LIFT STATION ❑ Required maintenance com Age of lift station y Lift station material Comment Which system tested (date installed) 2016 Adequacy test date 41W2020 ■❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 8.5 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 5.80 ft (min) Water added 825 gal ❑ N/A — pressurized field New depth 0 in ❑■ Monitor tubes go to bottom of effective. If not, state 415 depth into effective Elapsed time min ❑E Code -required soil cover over field Final fluid depth 0 in System presoaked 07Absorption rate ' 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: trench constructed in 2016 was tested for adequacy. Additional 40' length of trench was constructed April 2020. 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Property Line > 5' No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/ Ine > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft ing Tank? 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10' Animal Containment > 50' ❑ Yes if No ft es if No ft Yes if No it Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below COMM URi er Main? 75' ❑ 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' ❑✓ Yes if No ft Surface Water> 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: ❑✓ Absorption Field > 5' ❑✓ Yes if No ft Private Wells? 100' ❑✓ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells? 200'✓❑ Yes if No it Water Service Line > 10' ❑✓ 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 If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' 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. _�� X e_1 ffE,ERBS ��P :4Cq��¢ R .... �-A, Date. l 40.. 0 . .A • FE5510NP�'� COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-461-19 HAA# 1. GENERAL INFORMATION Complete legal description Meadow Ridge Estates, Lot 3, Block 2 T15N R1W Section 11 Location (site address or directions) 21045 Meadow Lake Drive Property owner Brian & Lynn Hattos Day phone 688-6518 HC 79, Box 6227, Chugiak, AK 99567 Mailing address Lending agency N/A Mailing address Day phone Agent Roll Milton/Heritage Real Estate Day phone Address 18550 Eagle River Eoad, Eagle River, AK 99577 694-4994 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~v TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X 'N If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA fi21 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 of this Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 694-5195 99577 Phone Name of Firm Eagle River Engineering Services Address P.O. Box 773294. Eagle Rvier, Ak Engineer's signature ?.L~--. ~4~--~ ~->> DHHS SIGNATURE '2~ Approved for '/'"/,~,"~9 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality et Anchorage Department of Healtt~ and Human Services (DHH$) issues Health Aulhodty Approval C;ertifieates ba~ed only upon the representations given in paragraph ~ above by an independent p~ole$$ional enginee~ registered in the Slate et Alaska, The DHH$ does lhi$ as a ¢ou rlesy to purchasers of homes and thei~ lending institutions in order to sati$l¥ certain federal and slate ~equirements. Employees of DHH$ do not conduct inspe¢lion$ o~ analyze data betore a certificate is issued. The Municipality of Anchorage i$ not responsible for errors or emissions in the professional engineer's wo~k. 724)25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /4r/¢;'4~('d /Z/./~E' ECT~5 Parcel I.D. 051¢ ~/¢/? Well type ~¢~¢/~ If A, B, or C, attach ADEC letter. ADEC water sys(em number present (Y/N) Date completed Driller Total de Cased to Casing height Sanitary seal Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot AT INSPECTION MU,~.~C")A' ITY r'F ~',F'r'HORAGE ENVIkGNMENT/L LER~ IC~S ~)IVISION '¢'.'i5.d. ~ 1993 RECEIVED ; On lots ; On adj, Public sewer main Sewer service line Public sewer Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: B. SEPTIC/~21 TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Other bacteria Tank size // OOO _Foundation cleanout (Y/N) Y - /"//'~' Alarm tested (Y/N) 0.~/"~9 ¢/~._,~ Pumper ~.~-/2/~ SEPARATION DISTANCES FROM SEPTIC/I:~.:cJ=E~G TANK TO: Well(s) on lot /V//~ To property line ,~ '~ ~ Compartments ~ J Depression (Y/N) /~¢/ . Surface water/drainage On adjacent lots '/' ~,' [,)f~ j Foundation Absorption field /D' Water main/service line ¢'/O 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N)_.~,,-- SEPARATION DIS_..T_.A-N~ FROM LIFT STATION TO: ~ On adjacent lots Manufacturer ~. ":' Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating Width ~' /<~ /SD 'f' ./,'~ ~ System type Gravel thickness {~ ~' '~ Total depth Cleanouts present (Y/N) y Date of adequacy test¢)~//~ c//c/_~ for -';~ -- Peroxide treatment (past 12 months) (Y~_~ /Vi,4 If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /',/ To building foundation // On adjacent lots Surface water Property line .~/ / To existing or abandoned system on lot ,/¥//~ Cutbank 'Z/'O / Water main/service line ¢- /,O/ Driveway, parking/vehicle storage area /D / Curtain drain /'/¢/')~ ,~/~,P,'~/'V'7" E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the dote of this inspection. , ~-. ~ r" ~ ~ ,'~:~ Engineer's Name Date HAA Fee $ / Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~--"~)\ -L~\LC~ \ -- \O\ NAA# GENERAL INFORMATION Complete legal description Meadow Ridge Estates ~1, Lot 3, Block 2 T15N R1W Sec.ll Location (site address or directions) 21045 Me~i. dow Lake Drive Property owner Mailing address Lending agency Mailing address AHFC 520 E. 34th Avenue, Anchoraqe, AK N/A Day phone 561-1900 99503 Day phone Agent Address Roll Milton/Heritage Real Estate Day phone 694-4994 18550 Eagle River Rd., Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: x If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA 02t '~JO~ s,Je@u!~ue i~uo!sse~oJd eq~ u! suo!ss!uJo Jo sJOJJe JO]. elq!suodseJ ~ou s! eSe~oqou¥ ~o A]Hed!o!un~ aqL 'penss! s! e~eo!jj~eo e eJo~eq e),ep ez~leU~ Jo suo!),oedsu! ~onpuo3 ~ou ap SHHQ jo see/~old LU:~ 's~,ueuue~!nbe~ a),e~s pue le~epe~ u!e~JeO/qsf~es ascap Jo u! suop, n~!~su! 8u!puel ~!eq), pue seuJoq jo s~eseqoJnd o), XseMnoo e se s!q), seop SHHQ eq.L 'eMSelV jo asa,S eq), u! pa~a~s!ae~ ~eau!6ua leuo!sse~oJd ~uepu@depu! ue Aq aAoqe 9 qde~aeJed u! ueA!8 suo!$eSueseJde~ eq~ uodn XlUO peseq se]eo!j!peo leAo]dd¥ X),poq~n¥ qlleeH sanss! (SHH(3) seo!A~eS ueuJnH puc q~leaH jo ~ueu~ped@Q el~e~oqouv ~o X~fled!o!un~ eq_L sluewwoo leUO!~!ppv :suo!~elndi~s 6u!~OllO~ aq] q$!/~ 'suJooJpeq JoJ. leAo~dde leUO!~!puoo 'paAoJddes!Q 'sLuooJpeq ~_~ .lo,t peAoJddv EildnJ.VN!91S SHHQ '9 eJmeua!s s.Jaeu[6u~ LL§66 ~ 'Za^TA a]:6e:~ '~6ECLL ×08 'O'c[ sseJppv §6]:~-~69 auoqd saaTA,~aS 5L~.:~aauT. 6u2[ :zaAT~ aT6e:2 LUJ!:I JO egUeN 'uoRaedsu! s!q~ jo a]ep aLIi uo ~3e~¢a u! suo!]eln6eJ pue 'saoueu!pJo 'sapoo e]e]S pue led!o!unF~l lie q~!/~ eoue!ldgUoo u! s! uJe]S/,S lesods!p Je]e/~e]se/~ Jo/pue Xlddns Ja]e/A @]!s-ua aq] 'uo!]oedsu! pue uoi]el~!],sa^u! AuJ LUOJ~ pue Sal!¢ aaeJOLIOU~' Jo X~!ledlo!un~ aq] LUOJ~ peu!esqo uOReLUJO~U! aq] ua peseq ]eq:), AJ!Je^ JeLI]JR¢ I 'u!aJaq pe]eolpu! aJn],onJ~s,[o edX~ pue SLUoo~peq JO Jequdnu eq~ Jo~ e~enbape pue leUO!]aun~ 'ajes s! Lue]sAs lesods!p Ja]e~e~se~ Jo/pue Alddns Je]e/~ el!s-ua aLIi ~eLI] S~OqS uoReO!ldde le^oJddv A]!Joq]n¥ q]leeH s!q], jo ua!lea!isa^u! ALu]eq~A~IJa^ I '~oleq u~oqsa~ep uo!~ep!le^eq~jo se pue o]eJeq pax!jla leas ALu Aq pa!~!uaa sv EEi~]NIgN:~ ),8 NOIJ. O~dSNI ..-I0 J.N:~IN:I.LV.LS .g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIS'r Legal Description: J~-R~Id I~II;¥_~E~:¢'~. ZDT" ~ ,~.,~ ~ Parcel I.D. -'l"/ 5,,u ,~ l ld 5 ~ . / ] A. WELL DATA Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Well type IfA, B, orC, attach ADEC letter. ADEC water system number Log-p"'Yesent (Y/N) Date completed Driller Total depthS'"'%_ Cased to_ __ Casing height Sanitary seal (Y/N)~'-.,. Wires properly protected (Y/N) '~0 MYNICIPALiTY OF i'." M WELL LOG AT IN S PEOL:~,/~JNMENTAL SERVICEsANCHORAGEDivisION Date of te'§t '~ ""!3t 0]99][ Static water level '~~ ~ i~?pEm~ V~D ,,~,.p.m. . . . Nitrate ~acent lots ; On adjacont~ Public sewer manhole/cleanbu,~ Petroleum tank % Other bact Collected by: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ~/'"~,, Tank size //~¢z~¢ Compartments Foundation cleanout (Y/N) )/ Depression (Y/N) Alarm tested (Y/N) /¢/'¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /*///) To property line '~? Surface water/drainage On adjacent lots )~ ~¢¢ ~ Foundation /¢)" Absorption field ?~ ce~-d Water main/service line /~ 72-026 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons %1~i (wY~e)r alarm level "Pu m p on" level ~...~.~. Meets MOA electrical~__ SEPARATI~NCE FROM LIFT STATION TO: Wel~n adjacent lots D. ABSORPTION FIELD DATA Manufacturer ~ Manhole~ ~ "Pump off" level at Cycles tested Surface water Date installed Length ,,"~-~' ~- Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /50 /'~//~,~ Gravel thickness Cleanouts present (Y/N) Date of adequacy test for Width System type Total depth bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~./,~1 To building foundation On adjacent lots Surface water Curtain drain ,// / On adjacent lots ¢' ~)~ / Propertyline ~' To existing or abandoned system on lot Cutbank /¢'¢ / Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Signature Engineer's Name I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff~(.ott,the~.date, of this inspection. ,r~''~ '' ' ~i~" '''~' HAAFee$ /?~ Date of Payment 72~026 (Rev. 3/91) Bsck MOA 21 Waiver Fee: $ Date of Payment Receipt Number A Eagle River Engineering Services 11940 Business Blvd, Suite /~205 'P.O, Box 773294 Eagle River, Ak. 99577 694-5195 Fax 694-3297 Legal: Owner: ,~ H,~ Date: aZ~/~f Type of test: [] Well Flow Test [] Septic 'fast Only [] Well & Septic Test rq Other: Meter Monitor Well Tank GPM Time Reading Level Level Level lO, y? 1.2: 3~ PSI Remarks DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 September 6, 1991 FOR: Eagle River Engineering PWSID 211431 My review of the records on file in this office reviews that the Dawn Water Company Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in ]"able C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Keven K. Kleweno Lead Engineer ~ primed on recycled paper I) y O.D. Property Owner Mailing Address Buyer APPLi,? "NT FILLS OUT UPPER HA' 'ONLY Phon~ (' ~ Address Lending Institution Address Realty Co. & Agent Zip Code Zip Code Phone Address Legal Description Street Location Ty p~.cf Residence _~:_~- Single Family [': Mulliple Eamily No. of Bedrooms ~ Other Water Supply t~R"'Com m unity __.~, Public Utility -Y~'? '-/ Sewer Disposal ~:~ Individual ~ Public Utility ~ 14olding Tank ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Year Individual Installed: \~! ~:'~-/ '-;~'> __ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. [)ate Inspector F:ield Notes: Date Inspector APPROVED BEDROOMS DISAPPROVED CON Dll'IONAL APPBOVAL' Date Inspe2tor Time Date lrlspeotor MUNICIPALITY OF ANCHORAGE [~;:~ ~ 'f& ENVIRONM2NI'AL PROTFCTION t~O Ci':'*~t"'""'~'~'.- ,:,FP RECEI _ 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank ~'J¢' ¢¢' Well Log Received Septic Ta~k Size ~ ~a~