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WALTER G PIPPEL ADDITION BLK 6 LT 8B
APPLICL T FILLS OUT UPPER HALI,.DNLY Property Owner /~/~/~//~/x(~ ~/'//,//~//'~Y~---~x/ Phone Address Zip Code Type of Residence [] Single Family Multiple ~ Other Family No. of Bedroon~s Water Supply ~. Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, [~ Community For wells drilled prior 1o that date, give well depth (attach log if available). [] Public Utility Sewer Disposal [] Individual Year Individual Installed:__ When Connected to Public Utility: ~ PuBlic Utility 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: ( ~¢'~PPROVED BEDROOMS (~' 'CONDITIONS OF APPROVAL ( ) DISAPPROVED '.AT O0"D''Oj'L Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Ta~k Size N.. c, 8 9 107 • • Municipality of Anchorage On-Site Water and Wastewater Program °- APRT 1 (907) 343-7904 s Y ti Certificate of On-Site Systems Approval 01 6 8 L 9 Parcel I.D. 050-123-55-000 Expiration Date: 7—/ ' l p 1. GENERAL INFORMATION Complete legal description Walter G Pippel Addition B6 L8B Location (site address) 16919 Coronado Rd Eagle River, AK 99577 Current Property owner(s) Geskey, Mark Day phone N/A Mailing address 1218 B. Tomahawk Dr Jber, AK 99505 Real Estate Agent Dev Enoroba Day phone 907-819-0050 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex E Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 9 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for. Distance: Received by: Date: 4///O// COSA to be released to the engi er,unle otherwise requested by the engineer. COSA Fee $ c: : (o— Waiver Fee $ Date of Payment 9 —1 Lk.335 3 Date of Payment Receipt Number a- ,311 Receipt Number COSA# 0`-)C-A8 \I�J 5 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 Alaska Rim Engineering, Inc. Phone 907-745-0222 Address 9131 E. Frontage Rd Palmer, AK 99645 Engineer's Printed Name Norman Gutcher Date 4/5/2018 OF 44. lit a 4+' p°°°..°°°0° �A H ow co°°�°a ` °OO° i�g1� 11 ' .0.17u(9 *45121 4 5 121 . 6. DSD SIGNATURE 0 v4; 6 0 0 040008•° 7p-of System #1 Approved for ! bedrooms c Normo}��f<`:isutcher System #2 Approved for bedrooms �4,-cp/,°°° CE-4919 s ° Disapproved ‘111/5)<i0 ��nROFESSI���P�s Conditional approval for bedrooms, with the following stipulate tie'�� ` 6—r• AI VC NIPS�5\ � cc\ N_ oNIPIRP ER sGPM pRp �' A1T SFQ\\G�, By: � �� ' 'f Original Certificate Date: 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 blue sheet_c c If more than 1 septic system is on the lot: • COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Waiter G Pippel Addition B6 L8B Parcel ID: 050-123-55-000 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) N Date completed N/A Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth N/A ft. Cased to N/A ft. Casing height(above ground) 21 in. FROM WELL LOG AT INSPECTION Date of test N/A 3/29/2018 Static water level N/A ft. 38.8 ft. Well production N/A gpm 7.0 g p m WATER SAMPLE RESULTS: Coliform A colonies/100 mL Nitrate 1 63 mg/L Arsenic <MRL ug/L Date of sample: 3/29/2018 Collected by: Brandon Jones B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout(YIN)" Depression over tank(Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (YIN&type) 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 N/A On adjacent lots >100' Absorption field on lot N/A On adjacent lots >100' Public sewer main > Public sewer manhole/cleanout >100' >75' >100' Sewer/septic service line Holding tank Animal containment areas >100Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS City sewer all distances meet well minimum set back. G. ENGINEER'S CERTIFICATION as'a-ww 1 certify that / have determined through field inspections and �C���ejp0°°oo.°�a*Q°.'01-ip ee„;` review of Municipal records that the above systems are in :. as ego conformance with MOA COSA guidelines in effect on this date. 0 4liggs p a o:o eosaa00 aoo a o Engineer's Printed Name Norman K. Gutcher ��L,e� �`�d ��(�3T,`?'� 'gyp �' f�` ��CitrFd�e�aa oe Date 4/5/2018 t��o °ri' C s 4 ,� 'ilkisb, CE-4919 ,f,;14/01,1 N,h —ed amu s07,,Did COSA canary sheet_2-6-15.doc �� PHOF'E N0. : 408 475 4366 Oct. 06 1998 07:34FM F1 F.ROM Jim_& Janet_Starr__ ,/V C1 f U , 4L-- s u.vU , - _....7- ..:...7._ _____ ___._ ___... w I . { � iNA1 I . Rt, _ k ! . ii•e‘truitutiptk\l /- ,... i. • : , \IN ti i 4t k ,J 4.1 • • Its � � ti ► r-•. I 'Iti..'l' t �. .ill ca� • RSA• a: { NI D (I •kl Q . !A J • .� ' �, + �.. .o . l _...'.610,0/".. iPa d . c.sau[LY-No CORNERS SET THIS DATE. • SE.�WARD & ASSOCIATESEYING LAND SURV688-4566 NrR eY CERTIFY THAT ; HAVE SURVEYED THE t SCALE* I ��aaIt\ 1 :OL:,OWING DESCRIBED PROPERTY* Lot 8E, 10 • 20' '• :+� OF A I fie. 31oc.c 6. Walter C. Pi p.pel Addn. I Q�,.• ...15. p DATE' r .r' . c- � ;�:� THAT NO EitCROGCiibi¢r�i 8 EXIST EXCEPT AS ,� • I� sOF T. t o��7192 c?:49 ••Y +D „�TrO. IT I5 THE RESPONSIBILITY THE s t ; , k f )WtsiD TO DETERMINE THE EXISTENCE OF ANY I BRIO' .11-27•. .t , --- ;ASEMEnN T S, COVENANTS, OR RESTRICTIONS ; . X32 i ����` ``� -,.�---`r t-rFg^•'" • ..1H ICH DO NOT APPEAR ON THE. RECORD; ? SUBDZ k _`.A•• Dy.w• xu,k Sw►.� ! ;ISION PLAT. UND NO CIRCUMSTANCES Sl�;Y.R.J t'FBr t �•. ...NY OATA Hit©N BE USED pOR CONSTRUCTION 1 29-70 "'t%''......... '• 'P 4 )F FENCE LINES, OR FOR E.TASLISHINU BOUND- ;t„,°R24-.L..$‘.11#4.4' .RY LINES_ t unr.nN, `t�vaN.... '"