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O V l Q " c m ) C7 Q (9 LL Development Services Department O sL Idin^y Scfety Division , v On -Site Weter & Wastewater program 4100 Brayaw Street P.O. box 196650 � Mark Sagich Anchoraae, AK 9 95 19-66 50 Mayor www e'Uni ore M'Firt 1907):43-7904 Pump Installation Log Well Drilling Permit Number. SW_ Date of Issue: Parcel Identification Number._ Legal Description Pr erty Owne;G�m�Ad�ess: HAamca Het'�htt, L I 6S 5-'p 'SJwioJ� —Zl7 �W Pump Installation Date: pump Intake Depth Below Top of Wen Casing;262 feet Pump Manufacturer's Name: Pump Model: Crn1��/ 0 5 Pump Size 1 hp Pitless Adapter Burial Depth: ! b feet Pitless Adapter Nlanufacturer's Name: W1655 Pitless Adapter Installer: A) f�- b`'ell Disinfected Upon Completion": :tZ Yes ❑ No iYlethod of Disinfection: Comments: Pump Installer Name: 41sJFS I�/lCf Vl7l/I��i QrC�2 +gym Attention: The pump irctallc shall provide a pump irstallation log to the DSD within 30 days of pump installatioa- Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5W 9% 01Z3 PID Number: D 1734 LZ/4 Name:I, S'PI4CL.L 41-11 C-5 Wastewater System: &Mloew ❑ Upgrade Address: q,Zlo �!`I`sVA�b bRI�E ABSORPTION FIELD Phone: / ' 2... T 4o s No. of Bedrooms: Fv u2 eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: tf S Total Depth from original grade: �� — °�• �' GPD/Sq. Ft. Lot: lock:' / '/ - L'Eubdivision: �[ y� 1. . W.. / 14Vk tjIL T/ n/ a • Depth to pipe bottom from original grade: = i/7 Ft. Gravel depth beneath pipe 7, 0 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 8 G Ft. Ft. Gravel width: Number of lines: Distance between lines: WELL: ew ❑Upgrade > 3 Ft. t / 7—/ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:?iyl 4D - 3 034, A_ -0/ p21�/ATC L71 Ft. C-71 Ft. 4.372. so. Ft. DriVelt Data Dri eed: Static Water Level: I Installer: / PI'S PSS Date Installed-4 ZS'L.1,/p 4 c..f $ L4/ 9 to ZS/ Ft. w�s.s+ Yield: Pump Set at: Casing Height Above Ground: I� TANK /D GPM Ft. Z Ft. SEPARATION DISTANCES ®'Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding PebIWPrivate Manufacturer: Capacity in gallons: '/, 7, SC:) From Tank Field Station Tank Sewer Lines L=• welr %J/a° �/3/' �/�.4 = 7�° Maters I get,/ Number of Compartments: Z Surface >/Soy >�so' �v/,�- n°� >ioo' LIFT STATION All*- Lot_ � — /5-1 /✓�if- °'/ � � / s' r Size in gallons: Manufacturer: " Line Foundation -S4.1 �9 r j� r Nl IVIA_ "Pump on' level at: "Pump off' level at: High water alarm at: CurtaiO�/� N� �/� N� N//� Pump Maio '& Model Electrical Inspections performed by: Drain n Remarks: ADDrrioA)A-I- /' o,- r-1LA_ -to BENCH MARK Location and Description, S /a A4) 06-6 04Q-& SE22to IA-" pry CA P Assumed Elevation: /0 b:• ENGINEER'S SEAL S19& Inspections performed by �T �'��— Dates:ls GT tx 2n G ... Department of He and a ervices approval /u 96 jY Reviewed and approved by� V v Date: k„q ,�� •• $” Permit No. 5W % 01 Z3 Page Z of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LO-rl, AkKAMA /47.50 A bom- AID- PID No.: 0173 q z 1V ' I . a � I A .I I I GA M 1. (�� .�99 � iYF1C:aw64 c� C. �"�19ce wfSaAin 7 teal.- k Y L i•° lfy v.g 9 ri• 1 S;Q s ow z &I 44Lr r l io M GRIFFIN ROAD 4*1 Permit No. :5\d 9/001 Z3 Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well inspection Report Legal Description: %o li01cAm4 ATS. 4JbIl. /Jo.I PIDNo.: 01"135�Z1� .— t)oj 91 _ 0 Fcou�uN�� �'r,�vA nn►� �, CLI qL 7s ilo 9 Z 7� From : ALPINE DRILL 907 345 0202 Sep.25.1996 12:48 AM P01 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT LOCATION OF WELL WATER WELL RECORD RDRDUGH BUBDIVIBIDN LOT BLOCK SECTIONQTRB BECTION TOWNSHIP RANBE MMD1AN ON OE [IsQw LOCATION/SKETCH:WELL OWNER: sem•• r DEPTHS MEASURED FR BOREHOLE DATA: Material Type and Color k top Clground surface WELL DEPTH; DATE OF COMPLETION Depth of hole:.A Z g It Depth Depth of casing: it Prom To DEPTH TO STATIC WATER LEVEL; �r it below to of casin C7 round surface ` Date: METHOD OF DRILLING: air rotary Q Cable tool 11 other USE OF WELL; a, domestic © irrigation ❑ monitor ❑ public supply ❑ other CASING STICK- P; tt. Diam: A in. to!gt6t Casing type: in. to wkuft WELL INTAKE OPENING TYPE: V open end ❑ screened ❑ perforated ❑ open hole 4 Depths of openings: to It P �s/ P SCREEN TYPE: Diam: in. ' Slot/Mesh Size: Length: it aq(08 GRAVEL PACK TYPE: Volume used, Depth to top: GROUT TYPE: Volume: RECEIVE Depth: from It to it OCI 141996 DEVELOPMENT METHOD: Duration: pnol Municipality Human & erVices PUMPING LEVEL AND YIELD: e t, Health AP } it after � hrs pumping gpm PUMP INTAKE DEPTH: it Horsepower: III WELL DISINFECTED UPON COMPLETION? ;RYIM ONO CONTRACTOR INFORMATION; REMARKS: V uyed PWines Nam PLEASE MAIL WHITE COPY OF IAO T0: Ignature o Authorized espres agve at�'e —�� DNR/DIVISION OF MINING & WATER MGMT 3001 C St, Suits 800 ANCHORAGE AK 99503-5935 M0,4 COPY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 11 11 2 PAGE 1 OF 1 P.O. BOX 196650, 825 L STREET, ROOM 50 ANCHORAGE, ALASKA 99519-6650 1Prn ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT 01CL) PERMIT NUMBER:SW960123 DATE ISSUED: 6/14/96 Lo °1l0 DESIGN ENGINEER':ANDERSON ENGINEERING EXPIRATION DATE: 6/14/97 OWNER NAME:SPINELL HOMES OWNER ADDRESS:9210 VANGUARD DR. ANCHORAGE, ALASKA 99518 PARCEL ID:01734214 LEGAL DESCRIPTION: HOKAMA HEIGHTS #1 LT 1 LOT SIZE: 41611 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENSURE PROPER TRENCH SEPARATION AS DESCRIBED BY AMC15.65.060.A1D. (14 FT. SEPARATION REQ'D FOR A 7 FT. EFFECTIVE DEPTH). RECEIVED P ISSUED BY: DATE: 411 b qG DATE:- 6S 0 June 6, 1996 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 1, Hokama Heights Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby apply for a permit to construct a well and septic system on the subject lot. Soils on the lot are conducive to onsite treatment and separation distances can be met to provide protection to the water source. The attached site plan shows the location and type of system planned for the lot. The surface of the lot slopes from northeast to southwest at a grade of 4% to 6%. Subsurface materials on the lot percolate "between 40 and 60 minutes per inch and no groundwater is evident in any of the testholes. The following statements apply to the proposed construction of the well and septic system: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern, will be maintained. Sincerely, }�� P . E v__-4 Michael E. Anderson, P.E. f0 i,. , E 4 ter AWChU iA6E ENVIRONMENTAL SERVICES DIVISION Attachments JUN OG 1996 �fM 4q � tb x4 S pM t � �fM 4q � tb x4 :iiV pM Qz LOT 1, HOKAMA HEIGHTS SUBDIVISION SITE PLAN SCALE 1" = 40' bE At M- oTZvAD _ LR�JDscanin(4 EASEM6-314-1T Ac,ccss . o poses _ y J Z *4 f _ ` � �tl °('' !` (976 '�°•ev �MRR '... 9 .,y S9 ®9f3 d /'1 CAt4 1 W LOT 1, HOKAMA HEIGHTS SUBDIVISION DESIGN FACTORS: Four Bedroom Home Perc. Rate: 40 Min./Inch Application Rate: .45 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gallon Septic Tank 7' Drainfield Rock 4 Bedrooms X 150 GPD / .45 GPD/SF = 1,334 SF of Absorption Area 1,334 SF/14 LF (Effective Depth) = 96 LF Of Deep Trench Therefore: Construct a Deep Trench System With 7' of Drainfield Rock and Two Laterals Each 48' Long at the Location Shown on the Site Plan. Distribution Pipe Placed at 4' Below Original Ground Surface. %u BAu�lc.t- 3 G��xri � FAaIj` Ak- AW / of 7-o DaA,aF(GW ROG�- r 5,10 .a u ♦R 6 GPbN �.��y TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Bottom of Trench to be 4' Above Groundwater c yea PA;dno,-; E. ndvm,, ; 44, Grade Area Over Trenches to Drain Away. � ,� 4331-e 0 Trench to be Installed Paralell to Slope.�f�na rsi Municipality at Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST . •sba ti U� PERFORMED FOR: LAN 1 ,r" DATE PERK LEGAL DESCRIPTION: AIVI[AM 4 Alw,4 M $v 6. Township, Range. Section: OEP#41 22 Aa DN. +SIO, SLOPE SITE PLAN 1 OM pi -IO L 2 3 .. . SP 6 —� !'i 7- 8 8 'b 9 , .: rZy 4381 -: - 10 /.� WAS GROUND WATER • ENCOUNTERED? 11 ��• I BbTrar+� IF YES, AT WHAT 12 DEPTH? Aa 13 coo to Weer Ater f btoe;mr;,lg? aft 14 17 Reading / , I BbTrar+� 16 o,•= d-3 140 - &c E 17 1s 19 20 MMENTS PERCOLATION RATE ffa (mma utiinen) PEAC HOLE DIAMETER TEST RUN BETWEEN 7` FT AND _. 6 FT FORMED BY: �' A fA4 44 t ��µ„A_ciFY THAT THIS TESWq3 PERFORMED IN -- - /, ! _ - Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: L of r I DATE LEGAL DESCRIPTION: 14O14AM4 I7W44M SVS. Township, Range, Section: DEP" �aa�t. NQ ! SLOPE 1 tom -/01 I—T�T1 f 1s 19 20 q PERCOLATION RATE 4P (mintttaaiinelt) PERC HOLE DIAMETER TEST RUN BETWEEN 7 FT AND 6 - FT COMMENTS I rNot c PXWSOAK 211" at To `i c sri IJ L WAS GROUND WATER t ENCOUNTERED? A IF YES, AT WHAT DEPTH? monfttno? As a.[G wIe 5 )g 4' L 1 a uar ori t bw'���yy ,g ,off Michod w Ardwwn SITE s ®=mm PERFORMED BY: MAU 44 ) FY THAT THIS //x�/•STy WAS PERFORMED IN kCC IRDANCE VATW At t CTATC Ak.n ul .uu.,nA. 11 unet u,rO ... 2 4- 6- 7- 7 .� 8- 5P 10- 0 12 12 •, . 13- 3 14- 1415 is - 16 16 i7 •/ 1 AmR 1s 19 20 q PERCOLATION RATE 4P (mintttaaiinelt) PERC HOLE DIAMETER TEST RUN BETWEEN 7 FT AND 6 - FT COMMENTS I rNot c PXWSOAK 211" at To `i c sri IJ L WAS GROUND WATER t ENCOUNTERED? A IF YES, AT WHAT DEPTH? monfttno? As a.[G wIe 5 )g 4' L 1 a uar ori t bw'���yy ,g ,off Michod w Ardwwn SITE s ®=mm PERFORMED BY: MAU 44 ) FY THAT THIS //x�/•STy WAS PERFORMED IN kCC IRDANCE VATW At t CTATC Ak.n ul .uu.,nA. 11 unet u,rO ... PERFORMED BY: MAU 44 ) FY THAT THIS //x�/•STy WAS PERFORMED IN kCC IRDANCE VATW At t CTATC Ak.n ul .uu.,nA. 11 unet u,rO ... ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Lot 1, Hokama Heights Subdivision GENERAL: 1. The scope of this project includes the procurement and placement of a 1,250 gallon Septic tank and the construction of a deep absorption trench with 7' of drainfield rock beneath the distribution pipe. A total length of 96 L.F. of trench is required. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 1, Hokama Heights Subdivision June 6, 1996 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 0 Lot 1, Hokama Heights Subdivision June 6, 1996 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. Lot 1, Hokama Heights Subdivision June 6, 1996 Page Four 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. lJ V Ll U ll V � C � PA L I 11 IJ 0 ll 3 (1 V C H O R�,/\ 'v' -+J L Development Services Department _ T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-342-14-000 Expiration Date: 9/15/2024 Legal description HOKAMA HEIGHTS #1 LT 1 Site address 5540 DE ARMOUN RD Anchorage AK 99516 Current property owner(s) BLANQUART FAMILY TRUSTBLANQUART ELISA A / TRUSTEE X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 2/7/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval_June 2022 MUG 0 C1 PAUTY OF ",ACHOO RAGE 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. 017-342-14 Complete legal description Hokama Heights #1 Lot 1 Location (site address) 5540 DeArmoun Road, Anchorage, AK 99516 Current property owner(s) Blanquart Family Trust 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone (907) 529-4497 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 27 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑® 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 $_ X70 Waiver Fee $ Date of Payment / 2 Z `7 Date of Payment i COSA # SC I I/ / Waiver # COSA Application—June 2022 Hokama Heights #1 Lot 1 017-342-14 6+ 8/24/96 271 N/A 271 3.58 18 8/28/23 Forge Engineering 225.8 1/2/24 49" 9/15/23* *A+ Home Services 6/26/96 11.5/11.7 N/A N/A N/A 8/28/23 1002 1440 > 600 84/84 72/3 12/81 Benjamin Schiller, P.E.1/11/23 (907) 522-7773 DEVELOPMENT SERVICES DEPARTMENT o,qf On-Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241011 Subdivision: Hokama Heights #1 Block: , Lot: 1 907-343-7904 Fax: 343-7997 The septic tank for this property is 27 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 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. # 01734214 HAA # 1. GENERAL INFORMATION Complete legal description Lot 1, Hokama Heights No. 1 Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Agent Address Spinell Homes 9210 Vanguard Drive Day phone 344-5678 Anchorage, AK 99518 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Four (4) Day phone Day phone 3. TYPE OF WATER SUPPLY: Individual well xxxxxx Community well Public water NOTE: If community well system, provide written confirmation from State',ADEC attest-!/ ing to -the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxxxxx k. Holding tank Community on-site Public sewer NOTE: 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 #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. Name of Firm Anderson Engineering Phone 563-7155 Address P•o• Box 240773 Anchorage:" AK 99524 Engineer's signature _L�etLy� Date 10/11/96 9 w 6. D7SIGNATURE ` = , ,,:',_,: •, ,:'': , - Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 1.01 By: Additional Comments UlTir The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Ftm. 1/91) Back MOA #21 Y Y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI(kECE ! V E Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 34 c47s141 4 1996 Municipality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist 4%A Legal Description: �-C'r i" /n&4 Ors, 140: Parcel I.D.: Z 1 A. WELL DATA Well type 'V'AT"C' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed N� Total depth Vj I Cased to Z l i Casing height (above ground) Sanitary seal (Y/N) Y Wires properly protected (Y/N)_ FROM WELL LOG AT INSPECTION Date of test '41� 7 1 Al 1A �r— Static water level z3 i " Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: u Coliform Nitrate ^ qqb A4 J �d-- Other bacteria Date of sample: didk/h i Collected by: 44 C= -A 6k.etjo Stiftp 4c : 01,/10 B. SEPTIC/HOLDING TANK DATA Date installed Tank size 4 Z'a70 Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) y Depression (YIN) <Q High water alarm (YIN) AJ Date of Pumping ^h;rw C. ABSORPTION FIELD DATA Pumper CC Al Sr " falOfJ Date installed 4P 19 4o Soil rating (g.p.d./ft2 or ft2/bdrm) o 4.5 System type b(� cz d Length " Width 3 e Gravel thickness below pipe " n Total depth Effective absorption area , rp �� /'. �T Monitoring Tube present(Y/N)Y Depression over field (Y/N)Aj Date of adequacy test AJC0 nI S77 Results (Pass/Fail) IPA SS For FL bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after Fluid depth (ins.) Minutes later: Absorption rate = _ Peroxide treatment (past 12 months) (Y/N) If yes, give date gal. water added (in.): 0 D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line > /0b t >/00t i cxC:-s On adjacent lots >/0oo On adjacent lots > / of Public sewer manhole/cleanout M 1 Lc -:.s Lift station ^JOAJ -'"" 0^1 LOT— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation > S7 t , Properly line ?/0 Absorption field >/Q / Water main/service line > ZS t Surface water/drainage >/00 Wells on adjacent lots >/00 t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: t i Building foundation > /D Water main/service line > Z - t � Surface water 1 > /QQ Driveway, parking/vehicle storage area > S� Curtain drain AJ49,4W onl 4pr Wells on adjacent lots y /©0 t Property line F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal records, that the above systems are in conformance with MOA HAA guidelines in effect on this date. r` t� A A Signature �� � � � n gar � Engineer's Name M PC.1-�*cL hFNA�so ung rieermg eaIHere, ill fhK,tle: 1 itc �-1�IK I: Date /0 // HAA Fee $ ) (")(:) Waiver Fee $ Date of Payment — k LA -Q l0 Date of Payment Receipt Number oa ,�( �� Receipt Number Rev. 8/95 OSS: haa.wk.doc 10/22/96 17:01 CT&E ESI ANCHORAGE d 5635389 CT$E Refs Client l(mue Project )game/# Client Stemple ID Matrix. Ordered By PWSf.M ME Environmental Services Inc. Laboratory Division Laboratory Analysis Report 965534001 Anderson Engineering N/A Lot l Hokama Efts Drinking Water NO. 987 P03 Client PO# Printed Date/Time 10/22/96 16! 11 Collected Date/Time 10/11/96 11:50 Received Date/Time 10/11/9612,00 Technical Director: Stephen C. Ede Released By C twoo-o Sample ,Remarks: Sample eollected by: Mike Anderson. Allowable Prep Analysis Paramet�ir Reoulta PGL Unita Method Limits Date Date [nit Nitrate N 0.996 0,100 mg/L SM18 4500-14031' 10 max 10/11/96 RAM Totat Otiform 0 0 ool/100mL SM18 92226 10/12/96 TMW 73 0e W/O CDL 200 W, Potter Drive, Anchorage, AK 99518.1605 —Tel; (907) 562-2343 Fax; (907) 561-5301 3180 Pager Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax:1907) 474.9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST vIRGiNIA 10/22/96 17:01 ';�:� CT&E ESI ANCHORAGE i 5635389 9 NO. 987 1705 CT&E Environmental Services Inc. Laboratory Division a /WTI 200 WPotter Drive Drinking mater Analysis Report for Total Coliform Bacteria Anchoiaee, AK 99618-1605 Tel: (907) 5132-2343 REAR &s7•RUCTiONS ON REVERSE SIDEBEFORE COLLECTING SAMPLE fax: (907) 561.5301 MUST BE COMPLETED BY WA"i"fit surrt tcr< p pU.BLIC WATER SYSTEM I.A. 0 C3 rWVATE WATER SYSTEM ❑ Send Results ❑ Send Invoice uct non. a.r Syron Ours, olemnv ea um er gas Mrs eY bung A Mn. .. v City Q ead Results O Send MOW N� � ►,i 6„ ! 41 r�1 c: �•t 0 �_ nano 44077,_ wing so U4 a I r Ih rn tlh V l FT SAMPLE DATE: V tui • Month Day Year SAMPLE TYPE: Routine p Repeat Sample (for routine sample Ah lab ref. no. ❑ Special Purpose SAMPLE LOCATION Comments: ❑ Treated Watel p Untreated Water M Time Collected Collected By 1�ysa AM �Me* PkP$e Mat Analysis shows this Water SAMPLE to be: Satisfactory. p Unsatisfactory C) Sample over 30 hours old, resulu may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail._ Date Received Time Received Analysis Began la Analytical Method: „>a/Membrane Filter MMO-MUG O + N11,1,00 -0 -1^vies/100 m1. Result* Analyst 5534—\5 hw W —� .,.... .r n.u.c..s,. Anch Fbks Jun F ed Data,. _••_.^_..._- Time: Client notified of unsatisfactoty results: Cl Phoned Spoke with Foxed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMo-MUG Result: Total Coliform E. Col/ Membrane Filter: Direct Count j 0,9 u% t) t Colonies/100 mi verine2don: LTB _ BGB COLIFTRM__ Fecal Coliform Confirmation Final Membrane Filter Aesuits ty Coliform/100 ml Reported B t*c V. `� Date r0. �� 'dime firs P Y ♦ y� A Y F Y ✓1� s�nAlo� rxrt: • fry Naalwa/ re COMM rig . mhff Neewta to) BOB Member of the SGS Group {SociAtd G4n6tele de Surveitlenoel �•IC r1 r.alnlC ..wbw wUn •r.nrnw.o ••.rnw•••v ..�.. .r-nn.r n.un ur.n-. .unr•rarra ew..www....n..-.• n...... -f. �.� ••ASYe r01 nCIMIA rl rlelnA CT&E Environmental Services Inc. Laboratory Division rPrrI��rr�►�ww�rrs•►�ri�rriiwlrl�r��'.rw�rs�orr�r.�i Drinking Water Analysis Report for Total Coliform Bacteria ee Drive A Qh Faget AK 99518.1605 READ INSTRUCTIONS 01YREYERSESIDEAE.FORECOLLEC77NGSAivy PL,E Fael: (90 562-2343 x:(907)561 5301 MUST ❑ PUBLIC WATER SYSTEM I.D. # ❑ PRIVATE WATER SYSTEM WA ❑ Send Rerulb ❑ Send Invoice aesy.r.m omprnr Nrme muc+nr.n. ane Mln .r el. u*� tf u mt Ad&mi in uue e p Sad Resulq ❑ Send Invoice t Q �2.d0j t�N G f P? �ttiLt AiLa u., nun. -- ib SAMPLE DATE: FI -71, Month Day Year SAMPLE TYPE: Routine ❑ Repeat Sample (for routine sample with lab ref. no. ) ❑ Special Purpose ,t SAMPLE LOCATION Lo Comments: ❑ Treated Water p Untreated Water Time Collected Collected By �- time Prim TO BE COMPLETED BY LAbVKA t vn = Analysis shows this Water SAMPLE to be: yt/ Satisfactory /❑ Unsatisfactory 0 Sample over 30 hours old, resultil may be unreliable Cl Sample too long in transit; sample should not be over 48 hours Old at examPnation to indicate reliable results. Please send new sample via special delivery Mail. Date Received (� ( (0 — ' r Time Received ��►l t`�' Analysis BegaIn Analytical Method: Pf Membrane Filter p MMO-MV0 " Numberofcolonies/100 mi. Result* Analyst 96.5497 ­ ]i Sent to A.D.6.C. Anch Fbks Juit Fased Date: ,_••_••r. Time: _ Client notified of unsatisfactory results: Phoned Spoke with Faxed Date Time: � BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coilform R. Coll Membrane Filter: Direct Count Colonies/100 ml Verification: LTB BGB COLIFIRM _ Fecal Coliform Confirmation Final Membrane Filter Results _ ___ ..C� ' Coliform/100 ml t ate fv Timev, Reported BY~lp rnrr - r.. Nemewr+ r. cwnr Oa - Oraer B*cmrr r h sGS Member of the SGS Group iSociitd Ginerale de Surveillance! -- _`