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PEREGRIN HEIGHTS LT 1
Lot ! #015-242-79 Municipality of Anchorage Page I o! ~-~ 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 Permit Number: .~ ~../L~ ~/Z-'7... PID Number: ..mo~ '~ "~'o ~~ Wastewater System: D New D Upgrade ~"": 7~q~ O~o. ~ H~'~ ABSORPTION FIELD Phone: I ~ ~,of Bedr~ms: _~ ~ Deep Trench ~Shallow Trench D Bed 0 Mound 0 Other LEGAL DESCRIPTION so. R...~: ~ I G~lvll Otlller: ,,elD: ~ GPM IPump Set Il: Fl. I~singHe'ghtA~"Gr*nd:FL TANK SEPARATION DISTANCES , ~septic ~ Holding ~ $.T.E.P. We,' I I ~ S~,a:. . ~ ~ LIFT STATION Line I 0 ~ Drain BENCH MARK Remarks: . ~.tion and Desc,iption: Inspections pedormed by: l~ ~ Date~:2ndlst ~,-. , C .... ~ · . Department of Health and Human Se~ices approval ,.'-' ~', ~"' ' ' .... ..,.. Reviewed and approved by: //~ ~ Date: I'll' ..... ,,.,..... N _~_ ~ . 49th ~'~ ' I ~ ~^~. No. cE-~5 .~ ~,~,~.... -- .. '*;~&' .................. ~2~ SCALD 1'~~ ., ...... .~.>?.:-:-:.:.:.:.:.:.:.5 ~ 0 5 ~ ~O[ Z5 ~ DEEP .~ ~ S[~[R S~IN~ ~IES; AC 41.7 ~ bIO 0£0£00~$ SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 LOT I PEREGR1N tlEIGtlT$ 7495 UPPER HUFFI~AN JERRY O£1f'HUR$1 SEPTIC SYSTEM AS BUILT DATE: OC~ II, 2000 SHEET: 2/3 GRID: 2740 5W000422 PID 015-242-7,° PCHOOO I 2. D~'/G STANDARD 5-PflDDE: 5 FT WIDE 2.5 FT DEEP .5 FT SEWER ROCK, EFFECTIVE $ FT COVER 4-1NCR INSULADON 49th No. c£-22~5 5' X 40' DRAINFIELD 91.0 6' BOl'l'OI4 T£STHOL£ A~RCONPR£$SOR ~ $10C¥Cl E ~000 MEYER ME 40 PUMP 5-WIDE DRAINFIELD LEGEND: B£N¢N ~14£K [OBBEN SPURKLAND P,E. 205 Wl5th Ave Ak 99501 I. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK $. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION LOT 1 PEREGRIN IIEIGtlTS JERRY DEWHURST SEPTIC SYSTEM SCHEMADC DATE: OC[. II, 2000 SHEET: GRID: 2740 SW000422 PID 015-242-79 PGHOOOI6.DWG MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTLm, NATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 05, 2000 Expiration Date: Oct 05, 2001 Permit Number: SW000422 Legal Description: PEREGRIN HEIGHTS LT 1 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Jeny Dewhurst Owner Address: 7495 Upper DeArmoun Rd. Anchorage, AK 99516- Parcel ID: 015-242-79 Total Bedrooms: 5 Site Address: 007495 UPPER HUFFMAN RD Lot Size: 86754 SQ. FT. Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: 203 W 15th. Avenue, Suite 203 ANCtlORAGE, ALASKA 9950 I (90'/) 2'/9-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 PEREGRINE IIEIGHTS S/D JERRY DEWllURST Municipality of Anchorage Department of tlealth and Social Services 8201 Street Anchorage, Alaska 99501 September 22, 2000 We are submitting an application for the replacement of the drainfield for this lot. The existing drainfield is located in the horse corral. This submittal consists of two (2) drawings showing the present improvements on the lot and the proposed drainfleld, (sheet ½) and a schematic of the septic system, (sheet 2/2). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Ground Water at I I ft. observed, lligherduring breakup Assume 9 ft. Use Standard 5-Wide Trench with BioC3'cle Soil Rating. From Testhole 09/I 1/00 2.5 rain/in = 4 gal per sq.ft/day No. of Bedrooms 5 Required Area per Bedroom: 150/4 = 37.5 sq.ft. Total arearequired: 37.5 x 5 = 187.5 sqft Top Rock At 2.0 feet Rock Depth 6 inches Bonom Rock At 2.5 feet Total Trench Length 187.515 = 37.5 ft USE 40 FT SYSTEM CONFIGURATION BIOCYCLE STANDARD 5-WIDE TRENCH TOTAL LENGTII 40 FT TOTAL WIDTH 5 FT TOTAL DEPTtl 2.5 leT ROCK DEPTll 0.5 FI' COVER 3 FT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface mnoffwill not result from this installation. · .... ?...~ / ,.~:.....o..-~....:2~ SCALE, 1'~~ ...,.. .... ':->:':':-:-:-:-:-:-:':':9 ~ 0 T~E~ ~0 ~ LO~ ~.~ ~ DEEP .$ ~ ~EWER SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 LOT I P£REGRIN tlEIGIITS 7~95 UPP£R HU££U4~ J££RY flEWHURSr SEPTIC SYSTEM DESIGN DATE: $£P~ 22, 2000 SHEET: 2/3 GRID: 2740 SWOOOXXX PID 015-242-70 PGHOOOI2. DF/G STANDARD 5-WIDDE: ,5 £T WIDE 2.5 F[ DEEP .5 FT SEWER ROCK, EFFECTIVE $ Fl' COVER 4-INCH INSULATION ,5' X 40' DRAINFIELD 8OrTOl~ T£STHOL£ ,41RCOI~P££$SO~ ~ BIOCYCLE 6000 MEYER I~E 40 PUIdP 5-1¢IDE DRAINFIELD LEGEND: B£NCtt ~OTTO~ /fLOOR SPURK~ND P.E. 203 V/15/h Ave Ak 99501 I. PRIMARY TREAT~IENT, SEPTIC TANK 2. AERATION TANK 3. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION LOT I PEREGRIN I1E1GtlT$ JERRY DEWHURST SEPTIC SYSTEM SCHEMATIC DATE: SEPT. 22, 2000 SHEET: GRID: 2740 SP/OOOXXX PID 015-242-79 PGHOOOI6. D~'/G PERFORMED FOR: LEGAL DESCRIPTION: 4- g 18 Munlcll:allty of Anchorage DEPARTMENT OF "tEALTH & HUMAN SERVICES 825 "L" Street, A.chorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST ~.~l~.~Township, Range. Section: SLOPE oF WAS GROUND WATER y ENCOUNTERED? S IF YES, AT WHAT ! ~ DEPTH? I,,~-,, p E OeplhtO Walk Alter t I /4 /.o, Monitoring? ' ' Oite; q/~-'~ /,,.,. SITE PLAN Feeding Date Gross Net DePth to Net Time Time Water Drop ~:'~ c, -- lo~1~ PERCOLATION RATE ~'~ {minutes/tach) PERC HOLE DIAMETER ~ q TEST RUN BETWEEN '~' FT AND ~ FT DISCLAIMFR' O, rn,ndwmtor cnnditlnns indicated are for the dates shown only. Past and future presence and/or depth of groundwater can not be predicted trom these observations. PERFORMED BY: ~. ~ __ I ~ ,~' CERTIFY THAT THIS TEST WAS PERFUMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll ELINES IN EFFECT ON THIS DATE. DATE: 72-~8 {Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 13- 14- 16 17 18 19 20. DISCLAIMK;~ · r, rnundwa t~r Past and future presence trom these oDsery~lons. PERFORMED SY: Munlcll: allly o! Anchorage DEPARTMENT OF -~EALTH & HUMAN SERVICES 825 "L" Street, Amthorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST [.~-~ 7'1 ~ r ~ ~rownship, Range, Section: I SLOPE WASGROUNOWATER ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? p E Oepth I~ Waler Alter Monitoring? Dele: SITE PLAN . I Gross Net Depth to Nit Feeding Date Time Time Water Drop _F../ q ~ ~1 ~/~ ~:~ I~ ~ ~ ~ ~/~ PERCOLATION RATE ~!~- (m,nutes/,nch) PERC HOLE DIAMETER ~ el TEST RUN BETWEEN ~ FT AND ~ FT cdnditinnR indicated ar~ fnr the dates shown only. and/or depth of groundwater can not be predicted ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll ELINES IN EFFECT ON THIS DATE. DATE: CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) Municipality of Anchorage ~ ~'age 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 Permit Number: ,~'~ q~,O i ~(.¢, RID Number: Name: MtC~ELS¢I4kt ~ ~/~ohH~E~ WastewaterSystem: DNew ~Upgrade *~d,~,~: ABSORPTION FIELD Phone: ~ No. of BeSoms: ~eep Trench ~ Shallow Trench ~ 8ed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: Lob Block: Subdiv~ion: Depth to pipe boHom from original grade: Gravel depth beneath pipe Number of lines: J 0istance between lines WELL: ~New ~ Upgrade Grave~ widm: Yield: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES o Septic D Holding ~ S.T.E.P. Fr~m Tank Field Ststion Tank Sewer Lines ~ ~m ~ s.~c. LIFT STATION Water Ix o ~ ¢ Line Lot ~-. t ~OI Size in gallons: lManufacturer: ~j 5~I ¢¢ "Pump cfr' lave at:il High water al¢m, at: Pump Mak~¢x¢ & Mc'lei [ Electrical Inspections~ performed by: Curtain Remarks: BENCH MARK / . ~ Assumed Elevation: ENGINEER'S SEAL inspections performed by: ~ G Dates: 1st Department of Health andHuman Services approval Reviewed and approved by: ~D¢*r~ ~' Date: 72-013 (Rev 9/91) MOA 25 N SCALE~ I~' = 50 FL PRIMARY TR£N£H m m m N m , SWING /-/ES; AC 55 FT BC 35 Aa 80 I BD 86 I *' REVISED: OCT, 7, 1996 BIOCYCLE SYSTEM TOBBEN SPURKLAND P.E. J J II 203 W ISTH, AVENUE ANOH. AK. 99501 LO'./' I PEREGRIN HEIGHTS UPPER HUFF~AN PAUL IdlCHELSOHN SEPTIC SYSTEM AS BUILT DATE: DEC, $, 1996 SHEET: 2/5 GRID: ~P40 SW960146 PID 015-242-79 PGHOOO12, DWG S[ANDARD 5-WIDDE: 5 FT WIDE 8 FT DEEP 2 FT SEWER ROCK, EFFECTIVE 6 FT COVER 4-INCH INSULATION 5' X 66' DRAINFIELD AIRCO~IPRESSO£ 96.0 91. ~" IE. 92.50 IE 92, 40 85.8 FOP OF ROCK BOTH ENDS BEMOH t~A£K BOTTOm( FLOOR 5- WIDE DRAINFIELD 85.4 BOTH ENDS BIOCYCLE 6000 MEYER ME 40 PUMP INSULA FlOR LEGEND; 1. PRIMARY TREATMENT, SEPTIC TANK 2, AERATION TANK 5. CLARIFICA T/ON TANK 4. DISCHARGE TAN/< 5. SOIL ABSORPTION TOBBEN SPURKLAND P.E. 205 W15fh Ave Ak 99501 LOT 1 PEREGRIN tlEIGH2'S PAUL MICHELSOHN SEPTIC SYSTEM AS BUILT DATE: DEC. 5, 1996 SHEET: GRID: 2740 SW960146 PID 015-242-79 PGHOOOI6. DWG ) ' ', ~"ERH:[T ~': ~1(~ '- 0',;.: MUNICIPALITY OF ANCHORAGE Depm'tment of Health and Human Services P.O. Box 196650 Auchm'age, Alaska 99519-6650 Date: To: From: Subject: December 31, 1996 File Daniel J. Roth, Civil Engineer, On-Site/Water Quality Program ~ Lot I Peregrin Heights, P.I.D. 015-242-79, Permit Number SW960146 Pursuant to the direction of the program manager, James Cross, P.E., the special provisions as stated on permit number SW960146 should not have been there and as a result will not be made a requirement of the permit/as-built documents. The review of this as-built will proceed without this special condition being regarded. CC: LOCATION OF WELL LOCATION/SI~ETCH: · 9 7~,~ ~ STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD ..... :J;;;'. ... , , ~~ ..... ~W ~~ , I ........ I , WELL OWNER: DEPTHS MEASURED FROM=~[~ce$1ng top []ground surface BOBEHOLE DATA: Depth Material Type end Color From To WELL DEPTH: Depth Of I'~ole: ~ ~ ~ ft Depth of casing: ~[, ~) ft ,ETLON DEPTH ~0 STATIC WATER LEVI~L: ¢~ ft below [~4op of casing [] ground surface M~HODOF DRILLING; ~airrotary ~ cable tool ~ other USE O~ WELL;~ domestic ~ irdoation ~ monitor ~ public supply ~ other ...... ~_ CASING It. Diem: ,~ In, t~ Casing typ0~ WELL INT~K~ OPENING TYPE:~ open end ~ SCreanad ~ perforated ~' open hole Depths of qponings: to ft RE Oept, Health ~ SCREEN TYPE: Diem: in. Slot/Mesh Size: Length ft GRAVEL PACK TYPE: Volume used: Depth to top; GROUT TYPE: Volume: Depth', from ft tO ft DEVELOPMENT METHOD: Duration; PUMPING LEVEL AND YIELD; ft after "?~, __ hfs Pumping PUMP INTAKE DEPTH: ft Horsepower: WELL DISit,FECTED UPON COMPLETION? ~',YES [~ NO CONTRACTOR INFORMATION: REMARK'~: ANCHORAGE AK 9BBO3-e935 Phone {907)269.8639, Fax {907}662.1.384 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 9951~-6650 PAGE 1 OF 2 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960146 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:MIMS HAROLD G OWNER ADDRESS: PARCEL ID:01524279 DATE ISSUED: 6/25/96 EXPIRATION DATE: 6/25/97 LEGAL DESCRIPTION: PEREGRIN HEIGHTS LT 1 LOT SIZE: 86754 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 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 lS.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 iS TO APRIL iS 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: 1 ) PRIOR TO CONSTRUCTION, TEST HOLE #2 MUST BE PROPERLY BACKFILLED WITH A GROUNDWATER MONITOR TUBE INSTALLED TO A MINIMUM DEPTH OF 12 FT. 2.) THIS GROUNDWATER MONITOR TUBE MUST REMAIN IN PLACE THROUGH THE SPRING OF 1997. 3.) FINAL APPROVAL WILL NOT BE GRANTED UNTIL IT IS DETERMINED THAT THE SYSTEM DOES NOT ENCROACH SEASONALLY HIGH GROUNDWATER. (MONITOR THROUGH SPRING 1997). IF IT IS DETERMINED THAT THE NEWLY INSTALLED SYSTEM DOES ENCROACH GROUNDWATER; THEN IT MUST BE REPLACED wiTH THE (ISF> DESIG PERMIT. ISSUED BY: ~ f ~~ DATE: T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 PEREGRIN HEIGHTS S/D NAME ~ KV~I> Ground Water at 12 ft. Use BioCycle Use 5-Wide Trench with 2 feet of rock Soil Rating. From test 8/30/96 16 min/in = 1.6 gal / sq. lt. No. of Bedrooms 5 Required Area per Bedroom: 150/. 1.6 - 93.75 sq.ft.. Total area required: 5 x 93.75 = 468.75 sq. ft. Total length Standm'd Trench 468.75 / 5 = 93.75 ft Reduction Factor ( 2 feet of rock) .7 Required Length: 93.75 x .7 - 65.6 ft Length of Trench 66 [FT.] SYSTEM CONFIGURATION Biocycle 6000 5-WIDE TRENCH TOTAL LENGTH 66 FT. TOTAL DEPTH 8 FT ROCK DEPTH 2 FT. COVER 6 FT. The installation of this septic system will not prevent wells from be installed on the adjacent lots. Them are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area, Ponding and/or concentration of surface runoff will not result from this installation. pg.1 Municipallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 10 11 13- [ 14- ~. 16 - O~ 16- 17 18 19- 20- COMMENTS. '(ENGINEER'S DATE PER OR ED'," Township, Range, SecUon; WAS GROUND WATER ~ ENCOUNTERED? DEPTH? I~ -- pO E MoniLo~ing? I~ _ Dale; ~ SLOPE SITE PLAN Reading Dote Gross Net Depth to Net PERCOLATION RATE ~ h~ (minutes/inch) PERC HOLE DIAMETER P~RFORMED BY; _ CERTIFY THAT THIS TEST WAS PERFORMED IN : ACCORDANCE WITH ALL STATE AND MUNiCiPAL GUiDELiNES iN EFFECT ON THi$ OATE. OATE: 72-~8 (Rev. 4/85) I I 25 50 7,5 IOD 125 I50 1018 REPLACEMENT O//5 PRIMARY TRENCH BioCycI~ 1033 REV/SED: OCT. 7, 1996 BIOCYCLE SYSTE~f TOBBEN SPURKLAND P.E. 205 W 15TH, AVENUE ANCH. AK. 99501 LOT I PEREGRIN HEIGHTS UPPER HUFFWAN PAUL ktlCHEL$OHN SEPTIC SYSTEM DESIGN DATE: JUNE 17, 1996 SHEET: 2/3 GRID: NB, tO SW960146 PID // 015-242-79 PGHO001 I.DWG STANDARD 5-WIDE: 5 FT WIDE 8 FT DEEP 2 FT SEWER ROCK, EFFECTIVE 6 FF COVER 4-INCH INSULATION 5' X 66' DRAINFIELD BOTTOM TESTHOLE 5-WIDE D£A/NFIELD BENCH WANK GARAGE FLOOR Aqqllprn rlrV mO, DO TOBBEN SPURKLAND P.E. 205 W151h Ave Ak 99501 ORIGINAL GROUND SILT BARRIER AiRCOMPRESSOR ~ 99. 7 AIR LINES ~ ~ ~ ~ ~ ~ ~ IE 95. J4 BIOCYCLE 6000 MEYER ME 40 PUMP LEGE VD: 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK 5. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION LO2' i PEREG£IN tI£IGttTS PAUL MICHELSOHN SEPTIC SYSTEM DES/ON DATE: OCT. 7, 1996 SHEET: GRID: 2740 SW960146 PID // 015-242-79 POHOOO16. DWG PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960146 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:PETRIKENAS,MICHAEL OWNER ADDRESS:7620 HOMER DRIVE ANCHORAGE, AK 99518-3247 PARCEL ID:01524279 LEGAL DESCRIPTION: PEREGRIN HEIGHTS LT 1 DATE ISSUED: 6/25/96 EXPIRATION DATE: LOT SIZE: 86754 (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 (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (MOT 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. 1 OF 6/25/97 2 SPECIAL PROVISIONS: 1. ATTACHED MATERIAL SPECIFICATIONS AND CONSTRUCTION GUIDELINES SHALL BE STRICTLY ADHERED TO. 2. AIR COMPRESSOR PUMP SHALL BE LOCATED IN AN AREA OR ENCLOSURE SO AMBIENT AIR IS NOT INJECTED INTO THE FILTER. 3. THIS OFFICE MUST BE PRESENT TO WITNESS CONSTRUCTION : MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 1. WHEN FILTER BOX IS CONSTRUCTED AND LEVELING COURSE IS IN PLACE READY ROF THE LINER TO BE INSTALLED. 2. PEA GRAVEL AND 6 INCHES OF SAND ARE IN PLACE, AND THE AIR LINE IS IN PLACE. 3. ALL SAND IS IN PLACE AND GRAVEL IS IN PLACE WITH DISTRIBUTION SYSTEM-L~ PLACE READY FOR THE PUMP TEST. PAGE 2 OF 2 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Well and Septic Permit Lot 1 Peregrin Heights June 18, 1996 Gentlemen; We are applying for permit s for this property. The design of the waste water disposal system is based on soil investigation conducted on May 13, 1996 as well as on soil reports on file at the Health Department. On May 13 we excavated five testholes on the property. Four of the excavations exposed soil that would not perc at the required rate. We also found several monitors and shallow depressions from testholes dug in 1993. The fifth testhole was located in the vicinity of an old testpit. The soil was a relatively loose sandy/silt, silty/sand with a perc rate of 6.15 min. per inch. No groundwater was observed.. Based on the marginal soil and the possibility of groundwater we feel that an ISF is the most suitable option roi' the lot. The design is based on groundwater at 4 feet and a percolation rate of 4 gallons per sq ft. Yours MUNICiPALI'IY OF ANCHOP, AGE Et, IVIRoNMEI4TAL SERVICES DIVISION RECEIVED 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 PEREGRIN HEIGHTS S/D MICHELSOHN AND DAUGHTER Groundwater a t 4 feet Use ORENCO ISF Percolation Rate 6.16 mid/in= Use 4 gal per sq.fl/day No. of Bedrooms 4 Required Area :4x 150/4 = 150 sq.ft,, Use 5- Wide Trench 30 feet long SYSTEM CONFIOURATION ORENCO INTERMITTENT SANDFILTER 5-WIDE TRENCH TOTAL LENGTH 30 FT TOTAL WIDTH 5 FT TOTAL DEPTH 3 FT ROCK DEPTIt I FT COVER 3 FT SEPTIC TANK 1500 GAL STEP The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST COMMENTS - (~NOINEER'S S ~EAL) Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S DEPTH? p E Depth Io Waler After t Reading Date Gross Net Depth to Net .c I ~.~' Time Time Water Drop 'pP.,E PERCOLATION RATE ~,/' ~ Immdtes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN J'? FT / I"~D (:~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, 72-008 (Rev. 4/85} CERTIFY THAT THIS TEST WAS PERFORMED IN II II II 50 I £50 L~f I ---1 I I I I LlgT £ VA£ANf HUFFMAN TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 LOT I PE£EGRIN I/EIGHTS UPP££ HUFFMAN PAUL ~/CHEISOHN SEPTIC SYSTEM OESIGN BATE: JUM£ 17, 1,9£6 SHEET: I/$ GRID: 2740 N 25 0 _ ~...~.~ ......... ..r..,~.,...~.,..~ ~ ,..~,~.,~~,~,.,,,~ .... 25 50 75 100 125 150 SCALE; l' = 50 F~ 1018 TOBBEN SPURKLAND P.E. I 203 W 15TH. AVENUE ANCH. AK. (907l LOT 1 PEREGRIN HEIGHTS UPPE£ HUFF/dAN PAUL IdlCHELSOHN SEPTIC SYSTEM DESIGN DATE: JUNE 17, 1996 SHEET: 2/3 GRID: ~'~0 Fro~ STEP Air Line 20 Cleon Du~ Access TOP VI£t~ ,5' PE,~ ~RAVEL D' TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907'~ 279-,~916 18x20 SAND FILTER LO[ I PEREGRIN HEIGHTS IdlCHELSOHN AND DAUGHTER SEPTIC SYSTEM DESIGN DATE: JUNE 17, 1996 SNEET: 2/4 GRID: ~740 DRAINFIELD 5 FT WIDE 50 FT LONG $ FT TOTAL DEPTH I ,CT OF ROCK $ FT OF COVER 1500 GAL STEP TANK $0.00 ft Sample Access, 8-filch Sump 5.00 fl ] MO SCALE 12" Sewer Rock ~~ 4" DisTribution Pipe- Mired 140 ~ 1500 Gol STEP BENCH /vlARK: BOTTOM SIDING ASSU~IED ELEK iO0. O0 FT 203 W15th Ave Ak 99501 LOT I PEREGRIN ItEIGHTS MICHELSOHN AND DAUGHTER SEPTIC SYSTFtd DES/GM DATE: JUNE 17, 1996 SHEET: GRID: 2740 Steven R. Pannone, P.E. Consulting Engineer P.O. Box 10295,1 Anchorage, Alaska 99510 (907) 272-8218 Legal: Owner: Residence: SEPTIC SYSTEM ADEQUACY TEST rt.. I,ot I Peregin S/D Mr. Mike Pertikenas 7495 Upper. Huffinan Ave, Anchorage AK 99516 Septic System: Tank Size: BioCycle Absorption System Type; 5-Wide Trench (from Municipal records) Absorption System Size: 66'x5'x2' Absorption Area: 471 s.£ installation Date: 11/26/96 Soil Rating: 1.6 gpd/sf Date of Pumping: 5-5-99 By: A+ Home Service Date of Test: 5-3-99 Test Procedure: System was inspected visually and measured. The drain field was found to have 61" of cover and a total depth of 85". There was 9 inches of liquid measured in the field's monitor tube. Water was from a pump truck to the fields monitor tube. Water levels in the tank and drain-field monitor tubes were monitored. A total of 750 gallons of water was added. During the test, the liquid level rose 15 inches in the drain field. There was no rise in the BioCycle. The infiltration rate was monitored fbr 30 minutes. During this period, a total of 750 gallons were absorbed. By the observations made, this system has an absorption rate 750 gallons per day at the time of the test. The well was tested at thc same time as the septic system. The well had a static water level of 37 feet below the top of the casing. It was drawn down to 52 feet below the top of the casing while it was producing water at a rate of 2.3 gallons per minute. The casing stuck-up 26 inches above the ground. PLEASE NOTE, this well draws its water from a bedrock aquifer. There is no gaurentee that this well will continue to produce water at this rate. Shifts in the bedrock ibrmation can increase or decrease the wells flow rate without notice or warning. Water was tested for bacteria and Nitrates. Test results are not available at the time of this writing, and will be forwarded once they are available. TESTS RESULTS: This system meets the code and operational requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational lifb of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee tha[:~¢.m.~rp.n0 hidden defects or encroachments. We can therefore not give any estimate of how long tlie',~f&~ ~i~e to meet the .-' ~ . ~ operational requirements of the Municipality and State. ':.:':~-O~ ~' ~, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D..' ~'0 1. GENERAL INFORMATION · Complete legal desCription · Location· (site address) COSA# ~(~--~(--~/~/ Expiration Date: Current Property owner(s) Mailing address Lending agency Mailing address Day phone 2~lff- 3'Z3~ Day phone Real Estate Agent Day phone MaitingAddress Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER O'F BEDROOMS: ~ ~ L,~, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well TYPE OF WASTEWATER DISPOSAL: r~' Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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. Nameof Firm -'")'p~.~,~.~/~,'~ ~0.?~ee¢i:].) 0"~ ~k Address ~ .o ~ ,~ve, 5~e. Zo% I' ~nc~r~% Engineer's Printed Name LA~5 DSD SIGNATURE ~ Approved for Disapproved. Phone bedrooms. Date Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 11/05) Original Certificate Date: Municipality of Anchorage. Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Pec~¢;~., ~.{~{'5 Lo-~ -~ Parcel ID: A. WELL DATA Well type Pr'lyf're. IfA, B, or C provide PWSID # ~ Date completed ~/1511'1~, Sanitary seal (Y/N) Total depth ~(~ ft. Cased to ~0 ft. FROM WELL LOG Date of test ~1151 lq ql~, Static water level Jo ft. Well production ..~ g.p.m. WATER SAMPLE RESULTS: · Coliform /Ve~ colonies/100 mL Nitrate i,33 mg/L , N'D uglL date of sample:, G/28/2m o Arsenic: B; SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size . ~,~,00 gal. Foundation cleanout (Y/N). Date of pumping -.--- Number of.Compartments· ~1. Depression over tank (Y/N) N' pumper. I~n~,,~ ~w I Well Log (Y/N) Wires properly protected (Y/N) casing height (above ground) AT INSPECTION 30,~ ft. i,t/ g.p.m. Other bacteria .N'~ Collected by: ~-A~s Y 29 in. · colonies/100 mL Date installed Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed il!'/-~litl~{,,, Soil rating (g.p.d./ft Length t'{O ff. Width. .~ ff. Total depth /"{ ~5 ft. Eft. absorption area ~.00 ft2 Monitoring tube Date of adequacy test. ~J?.317.ooi Results (Pass/Fail) ~a5.5 · Fluid depth in absorption field before test ~ in. Water added ~ gal. Elapsed Time: [0 min. Final fluid depth O in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ./~o System typ~]~tD Gravel below pipe O~ ft. Depression over field For ..~ bedrooms New depth ~ in. ~.50 g.p.d. If yes, give date D. LIFT.STATION Date installed {I "Pump on" level at .15 in. Datum E, SEPARATION DISTANCES Size in gallons,,, "Pump off" level at ~tl~. in. Cycles tested ,~+ Manhole/Access (Y/N) "/ High water alarm level at ~t/z '~ Meets alarm & circuit requirements? "~e,5 in. ~ SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on lot Absorption field on lot IOO' ~- · Public sewer main ..... Sewer/septic service line '2. S Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank ~v/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $1+ Property line 5 I+ Water main /V'/A Water service line {0'4- 'Wells on adjacent lots riX) 4- Absorption field 5 t+ I Surface water [oo ~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io 4- Building foundation Io~ + Water main Water Service line. I O' ~- Surface water %OO'-I- Curtain drain COMMENTS t Wells on adjacent lots ~Oo 4- 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. Engineer's Printed, Name k tl¢.~ ,oQ'~ucYL~o.~t~ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) % Driveway, parking/vehicle storage ~O ¥ Waiver Fee $ Date of Payment Receipt Number SGS Reft# 1103094001 Client Name Spurkland Engineering Printed Date/Time 06/30/2010 13:54 Project Name/// Water Samples Collected Date/Time 06/28/2010 15:00 Client Sample ID Peregrin Heights LI Received Date/Time 06/28/2010 15:50 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<I0) 06/29/10 06/30/10 NRB Waters Department TotalNitrate/Nitrite-N 1.33 0.100 mg/L SM20 4500NO3-F B (<10) 06/28/10 AYC Microbiolo~Ar Laboratory E. Coli Total Coliform Negative I 100mL SM20 9223B A 06/28/10 DLC Negative 1 100mL SM20 9223B A 06/28/10 DLC AI)V ANC El) Vv'ASTEWATER TRI]ATMENT SYSTE~;I MAINTENANCE AND REPAIR AG REEM ENT MEMORANDI~M OF [~NDERSTANDIN(; BETWEEN ML~N!CIPAIATY OF ANCHORA(;E l l tiS MEM()RANDt!M O1-' I~ NI)I~RSTANI)IN(; made and entered into as of this herein thc "()WN1;'R." and the Municipality oFAnchorage, herein the -M(~NICIPAI~ITY." In consideration of tl~c mutual covenants contained herein. parties to this Memorandum (d'l .nderslanding agree as lk,Jloxvs: 1. ADVANCED WASTEWATER TREATMENI' SYSTEMS. grants permission to ()x~ncr to utilize and operate an Advanced XYaslewater I'-can'ncn~ Sxstcm (AWW'I'S). dcscribcd as '~i i~ at ~ '~! 5 ~?.~7..5~ 5~ ~/q 017 ?,~"SD ........... . A ncho rage. A]aska. 2. A. Alteration. ,knx change lo thc design or lkmction of an AWW'I'S thai Includes thc installation or removal or'any paris, conlponents or pieces not inclt~ded in the original constrttction permi[ ami design. Prior to pcrlbm~ing a~y altcralio~]s to an .,'~ ~¥ WT5 lhc o~qlcr must obtain a Wastcx~alcr I)isposal System ('onstruction t'crmit l]Xqll thc Mtmicipalily ptn'sumn ~o Anchc, ragc Munici pal ('ode (here na tier. "A MC"i 15 65. f~. ("erlitlc~le ofOn-Sile Systems Approval. An approval by thc Mtmicipalilv ~,l'cxisting water and wastewater disposal syslcms gix cn thc time of pn)pert5 sale and title transtbl' in accordance with AMC 1 hese approvals certil? that thc systems are adequate for fl~c homes that thc~ support and mec~ Ibc codes ~hat were in place a~ the time oF?stem constmclion. Damage. An? man-made or natural change in a system 0mt would inhibit thc system (5'c,m pcrlbrmh~g as designed. l). Maintenance and Repair, The scheduled and as needed replacement of existing parts, components and pieces of an AWW't'S that were included thc oriainal, dcsio n. pcrfi~rm as dcsioned 15, Permit ((7onslruction) An ¢)n-Site ~'aslewaIeF Disposal Nvstem Co~struction Permit as defined h)AMC' 15,~5. I:. Permit (Operating) An Advanced Wastc~'alcr Treatment System ()peral'i~ag Permit, An annual pe)'mit, issued by the Municipal}t5. thai al loxvs the {,)wner to operate an AWW l'S. upon meeting all the requircmcnt:; oF this agreement, thc conditions ni:'f)pcraling Permit, thc requiFements oF thc ()n-Site Wastcwater System ('onstruction Permit and all rcievam provisions of AMC' 1 5.(~5 ~ Fee. (~vner shall pay h~ Munic}palitx. (S_.~,'..00). payable on or bclbrc the issuance ot"U~c opera~iF~g permil and annuallx thereafter, l'hc annual l~c is due on or beFOre thc an~lix, crsar5 date of the approval by thc Municipalhy ~ F insta I lcd system. 4, Term. 'I hc Icrm oFU~is Memorandum ol'Iindcrstanding shall be tbr linc titk of thc Thc term begins on thc date of approval by Ibc Municipality of the installcd system and shall continue while Ibc AWWI'S svsmm is in usc or operational or until thc properly soid or lille is translkrrcd by owner and a new cc]'tificatc oF()n-Sitc approval is issued thc new o~.~ncr or translkrcc of the properly. 5. Al/erali0ns~ lnslallalion and Remo~'al of Additional Equipment. ()v~ncr ttot 1o make any alterations, removal oI" paris or adt ithms to the AWWTS ~xilhout Constn]ction Permit fi'om thc Municipality. 6. Maintenance and Repair2. A. Thr(mghoul thc term oF this Memorandum of'[ lndcrslanding thc ()wncr ,;hall maintain/XWWI S in good rcpah'. In addition, it shall bc thc responsibility of {)wncr during thc term of this Memorandmn oft Fndcrslanding. and anx extensions rcnc~als thcrcof2 at 111c OWtlCi"s sole CXpCllSC. tO pa} lbr any alld all: (l) Fcpair(s). maintenance. ( 3 ) adjt~stmcnt(s). (4) replacement costs, and (5) inspection costs. [:re'thor, ()xvncr agrees ~o comply will alt applicable ordinance, laws. rcguJalions. rules and ordcFs IhT' thc AWWTS. 13. ()~.ncr agrees to provide thc Municipal t? a ~riticn schedule of romine maintcmmcc alld repairs which haxc bccn pcrlbrmcd on llqc system pur:~uant lo the lcrms and conditions comaincd in thc ()x~ncr's AWW'I'S t)pcrating Permit. This schedule shall be :qdmfitted to the Mtmicipa}ity annually upon thc rcnc~aI permit, l'hc schcdutc of maintenance and repair contai]'~cd in thc ()x~ncr's ('. ()~tt~er ack ~o~x edges that thc linc schedule Ibr fihling to maintain ~md repair ~X~.~¥TS arc coditled in AM(' 14.60. 1). Owner agree,q that only maintenance, repair personncI certified by the N.'hl)~ici[)ality will inspecl and make any necessary maintenance, repairs or permiltcd alterations t,.~ the :qystem. ti. ()whet agrees h~ grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. I:. ()xvner ~grccs thai an~ sale or transl~tr o~'titlc oi~thc properly will not occur without a new ('c~ificatc ol'()n-Sitc Systems Apprt~val. (i. (')wncr agrees thal thc relevant provisions of thc slandard specification guidebook fi~r AW WTS is thc governing pro~bssional guidelines I}~r the conslruclion~ maintenance and repair of thc ()wncr's AWWTS. 7. Nonwaiver. Thc fifilurc of either part5 at any time lo enlbrcc a provision of this Memorandum oI'1 h~derstanding shall in no ~.ay constitute a waiver of thc provisions, nor it~ a~v x~[ty el't~cI thc x'aliditv of thc Memorandum of [l~derstanding or an)part hcrcolL or thc right ~>1' such party thercat'~cr to cnfi~rcc each ami every provision hereof'. 8. Amendmenl. A, lhis Memorandum o~'tJnderstanding shall only hc amended, modified or changed by a x~.riting, cxeculed bx m~thorizcd represenmtixes ~I' thc parties, with thc smnc fbrmalitx of this Memorandum of [ indcrstm~ding w~s executed and such writing shall be altachcd to this Mcm~randmn ~,t'I rndcrs~anding as an ~m~cndmcnt, B. For Ibc purpo>4es of any itmcndmcnt modit~cltticm or chat~gc to the tcrlp, s and conditions of this conlract, thc o[~lx authorized rcprcscmatives of tine parties arc: Anc borage: ~u_r~t_~j._s in__g.~ Office r ('. An? attempt to amend, modii\, or chan,,e this contract by chhcr ;m tmauthorizcd representative or unat~thorizcd means si~all be void. 9..Jurisdiction: Choice of Lnw, Anx civil action arising from this Memorandum of l.~ndcrstamting shall be brought in Iht Superior ('ourt t~r lhe Third Judicial l)istrict of the S~alc of Alaska at Anchorage. Thc laxvs of Ibc S~atc of Alaska shall govern thc rights and obligations oflhc parties trader lhis Mcnmrandum of Understandiag. 10. Severabili~. Any provisions or,his Memorandum ol tJnderstanding decreed invalid b5 a courl ~1' conqpelent jurisdiclion shall not invalidate Ibc remaining provisions of thc Memorandum of i 5ndersta~ding. ()V~'NER= I)at" Date: STA 1"}! ()}, At~ASKA ,MIINI(711~AI. ITY: ) )ss. ) 50' 50' 0 0 S 89'57'27" E 309.82' --t--W,.~._lO'XSO' GUY AND ANCHOR ESMT. S 89°58'00'' E LOT I SEPTIC --~ GUY ANCHOR POWER POLE 509.82' LIGHT BASE LOT 2 UPPER HUFFMAN ROAD Legal Description: Peregrin AS-BUILT Lot 1, Heights Subdivision NOTE: .THIS DRAWING SHALL NOT BE MODIFIED FOR USF. AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. Ord.~ed 8~. Jerry Dewhurst/Remox Legend: Septic Standpipe War. We,, Fence~X X~ SURVEY CERTIFICATION: LANTECH has conducted a physical survey of the property os shown on this drawing and certifies that the improvements situated thereon are within the property lines and no encroachments exist other than noted. , EXCLUSIONARY NOTE: It is the owners* responsibility to determine the LAND &: CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS existenCe of any e~sements, covenants, restrictions or right--of-way --,~ ,,, · ,~ .................. I takings whiCh do not appear on the recorded subdivision plot. Under ~,~+~.wes~ ~e.?so, n ~_o_uie_~ra, ~u,~e zuu .none: ooz-oz~'~I n° c,~cu,.Ston:es .hou,d any data ~e~n ~e used ~o~ ~on~t~Ctio., ncnoroge, AIOSKO 99~t)J Fox: 561-66261 for establishing property lines, or for plot-plan purposes. i~? '-~27 759/46 : 01-L-269 1=60 Ch.c~ed e~ JMZ BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell EmaiI: biocyclealaska~gci.net Customer Jerry and Shirley Dewhurs~ ~ Upper Huffman Anchorage, AK 99516 345-6026 4th Qtr Maintenance 2009 BioCycle Location Upper Huffman Install Date: October-96 Tank #: 26 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL AERATION CHAMBER & AERATION BLOWER SIZE AERATION PRESSURE NOISE LEVEL GENERAL CONDITION o=o HIGH 8{5 120 L/MIN HIGH LOW } HIGH POOR PIPING ~ LEAKS ~ POOR YES CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER CLARITY OF EFFLUENT HIGH AIR CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING ALARMS CHECKED AND AIR/POWER tllGH WATER COMMENTS NO OPERATING~ NONO 4th Qtr 2009 Maintenance was performed today BY: V~~~ ~'__ DATE: BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell Email: biocyclealaska~gci.net Customer Jerry and Shirley Dewhurst ~ Upper Huffman Anchorage, AK 99516 345-6026 3rd Qtr Maintenance 2009 BioCycle Location Upper Huffman Install Date: October-96 Tank #: 26 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL ltl(iH AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE ~ 80 120 L/MIN AERATION PRESSURE ~HIGIt LOW NOISE LEVEL HIGIt GENERAL CONDITION POOR P1PING SYSTEM: AIR LEAKS LEAKS AIR DIFFUSEP, IAIR SUPPLY POOR MIXED LIQUOR CONDITION ODOR YES CLARIFICATION CHAMBER SLUDGE ACCUM IN }lOPPER CLARITY OF EFFLUENT tllGH FAIR CLOUDY DISCHARGE CHAMBER I)ISCHARGE PUMP OPERATING /'"'Y'ES '~ NO Al. ARMS CHECKED AND OPERATING ~ /\IR/POWER ES HIGIt WATER ~ NO NO COMMENTS 3rd Qtr 2009 Maintenance was performed today ....... ........ h }Y: / BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell Email: biocyclealaska~gci net Customer Jerry and Shirley Dewhurst 7-400- Upper Huffman Anchorage, AK 99516 345-6026 2nd Qtr Maintenance 2010 BioCycle Location Upper Huffman !Install Date: October-96 Tank #: 26 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEi,: O AERATION CHAMBER & AERATION SYSTE BLOWER SEE AERATION PRESSURE NOISE LEVEL GENEILAL CONDFI'ION SYSTEM: AIR LEAKS AIR D][FFUSER/AIR MIXED I,IQUOR CONDIT[()N O[X)R CLARIFICATION CHAMBER SLUIXqE ACC UM IN HOPPER CLARITY OF EFFLUENT DISCHARGE CHAMBER DISCHARGE PUMP OPERA"lING HiGH 80 120 I./MIN HIGH LOW POOR PIPING LEAKS [>()OR YES HiGH FAIR CLOLYDY NO ALARMS CHECKED AND OPERATING/"~x AIWPOV~TR ~ NO ItlGI [ WATER NO COMMENTS 2nd Qtr 2010 Maintenance x~as perforated today BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office .~ -v_~.~ 1 cell Email: biocyclealaska@gci.net Customer Jerry and Shirley Dewhurst ~pper Huffman Anchorage, AK 99516 345-6026 1st Qtr Maintenance 2010 BioCycle Location Upper Huffman Install Date: October-96 Tank #: 26 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM I,EVEL ~ AERATION CHAMBER & AERATION SY~ BLOWER SIZE AERATION PRESS[IRE NOISE LEVEL GENFJLAL CONI)ITION SYSTEM: AIR LEAKS ArR DLFFUSER/AIR SUPP1,Y MIXED LIQUOR CONDITION } lIGHT '~ [tlGH &~ POOR PIPING ~ LEAKS ~ POOR ()DOR N~ YES CLARIFICATION CHAMBER SLUI)GE ACCUM I2'4 CLARITY ()F HIGI I F'AIR CI,OU1)Y DISCHARGE CHAMBER DISCliAR(}I:'. PI ffcIP ()PEPo\TtN(i NO ALARMS CHECKED AND OPERATING/,~t AIR/P()V~TR HIGH WATFR NO N(.) COMMENTS 1st Qtr 2010 Maintenance was perforated today BY: LARRY BE'ITS DATE :~._'__~.__~)__ BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell EmaiI: biocyclealaska~gci.net Customer Jerry and Shirley"'Bewhurst -7,46:~ Upper Huffman Anchorage, AK 9951 345-6O26 3rd Qtr Maintenance 2009 BioCycle Location Upper Huffman Install Date: October-96 Tank #: 26 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE AERATION PRESSURE NOISE LEVEL GENERAL CON DIT[0N SYSTEM: AIR LEAKS AIR DIFFUSEP, JAIR SUPPLY MIXED LIQUOR CONDITION ODOR HiGH 80 120 L/MIN HIGH LOW HIGH POOR PIPING LEAKS POOR YES CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER CLARITY OF EFFLUENT I41GH FAIR CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING ALARMS CHECKED AND OPERATING -'~x~ AIR/POWER HIGH WATER NO NO NO COMMENTS 3rd Qtr 2009 Maintenance was performed today BY: ~/..~t~~_.- DATE: (,/' 7,y, - v-- .... 55un c pa ty Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343~4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-242-79 1. GENERAL INFORMATION Complete legal description Lot 1 Pereqrin SID HAA# 14/~ qqOiqq Expiration Date: Location (site address or directions) 7495 Upper Huffman Current Property owner(s) Day phone Mailing address 7495 Upper Huffman Lending agency Day phone Mailing address Real Estate Agent Ms. Vicki Grief Day phone 265-9149 Mailing Address Fortune Properties Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class. Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on propedies served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (Rev. 11/99) STATEMENT OFINSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation .............................. .. , ,pp, o.~, Guide!ines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and .a,=q,,ate ~,r th,=, nl hat ~','~ hadranm~ an~ fna af cf filch irc indicated herein I fur(her verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Address P.O. Box 102954, Anch. AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. DHHS SIGNATURE /--'" Approved for ~ Disapproved. Conditional approval for bedrooms. Phone 272-8218 Date 311912000 bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: Expiration Date: (Rev 11/99) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Reissue Date: MuniCipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343~,744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type pRIVATE Date completed 7/t5/1996 Total depth. 266 ft Lot t Pere.qrin IfA, B, or C provide PWSID # .__ Sanitary seal Y Cased to. 20 ft Date of test Static water level Well production 5 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 3/1212000 B. SEPTIC/HOLDING TANK DATA Tank Type/Material BIOCYCLE Parcel I.D.: 015-242-79 FROM WELL LOG 7/15/1996 20 ft g.p.m Nitrate 0.919 mg/I Collected by: SRP Well Log Y Wires propedy protected Y Casing height (above ground) 26 in. AT INSPECTION 5/3/1999 37 ft 2.3 g.p.m Date installed 11126/1996 Tank size __ Cleanouts __. Foundation deanout _Y Date of pumping 5/6/1999 Pumper A+ HOME SVC C. ABSORPTION FIELD DATA Date installed 1112611996 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.6 Length 66 fl Width 5 ft Other bacteria 0 colonies/100 mi 1600 gal Number of Compartments _4 Depression over tank _N High water alarm Y__. System type 5-WIDE Gravel below pipe 2 ft Total depth 85'._~' ft Effective absorption area 471 ft2 Monitoring tube Y Depression over field Date of adequacy test 5/3/1999 Results (Pass/Fail) PASS For_5 bedrooms Fluid depth in absorption field before test 9 in Water added750 gal. Elapsed Time: 3_0.0 min Final fluid depth _9 in Any rejuvenation treatment (past 12 mo,) (YIN & type) N New depth2~4 in. Absorption rate >= 760 g.p.d. If yes, give date. (Rev. 11/99) D. LIFT STATION Date installed 11/26/1996 Size in gallons 1600 "Pump on" level at 25 in"Pump ofF' level at Datum RIM Cycles tested 5 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 44.5 in Septic tank/lift station on lot Absorption field on lot 130 Public sewer main N/A Sewer/septic service line 90 104 Manhole/Access Y__ High water alarm level at 22.5 in Meets alarm & circuit requirements? Y On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout Holding tank 104 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line 55 Water service line 100+ Wells on adjacent lots. 100+ Building foundation 35 Water main 50 Drainage 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 53 Surface water 100+ Wells on adjacent lots 100+ Property line 30 Water Service line 100+ Curtain drain 100+ F. 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 HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date 3-19-00 N/A Absorption field 20 Surface water 100+ Water main 100 Driveway, parking/vehicle storage 40 HAA Fee $ Date of Payment Receipt Number (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number &even R. Pannone, P.E, Consulting Engineer Legal: Owner: Residence: Septic System: SEPTIC SYSTEM ADE~_~._U_~ TE~ST Lot I Peregin S/D Mr. Mike Pertikenas 7495 Upper. Hnffinan Ave, Anchorage AK 99516 P.O. Box [02954 Anchorage, Alaska 99510 ~.(~_OJ) 272-8218 Tank Size: BioCycle Absorption System Type: 5-Wide Trench (from Municipal records) Absorption System Size: 66'x5'x2' Absorption Area: 471 s.f. Installation Date: 11/26/96 Soil Rating; 1.6 gpd/sf Date of Pumping: 5-5-99 By: A+ Home Service Date of Test: 5-3-99 Test Procedm'e: System was inspected visually and measured. The drain field was lbund to have 6 I" of cover and a total depth of 85". There was 9 inches of liquid measured in the field's monitor tube. Water was from a pump truck to the fields monitor tube. Water levels in the tank and drain-field monitor tubes were monitored. A total of 750 gallons of water was added. During the test, the liquid level rose 15 inches in the drain field. There was no rise in the BioCycle. The infiltra'tion rate was monitored for 30 minutes. During this period, a total of 750 gallons were absorbed. By the observations made, this system has an absorption rate 750 gallons per day at the time of the test. The well was tested at the same time as the septic system. The well had a static water level of 37 feet below the top of the casing. It was drawn down to 52 feet below the top of the casing while it was producing water at a rate of 2.3 gallons per minute. The casing stuck-up 26 inches above the ground, PLEASE NOTE, this well draws its water from a bedrock aquifer. There is no gaurentee that this well will continue to produce water at this rate. Shifts in the bedrock fbrmation cm~ increase or decrease the wells flow rate without notice or warning. Water was tested for bacteria and Nitrates. Test results are not available at the time of this writing, and will be forwarded once they are available. TESTS RESULTS: This system meets the code and operational requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system trader the conditions encountered at the time of the test, and separation distances measured to readily identifiable fbatures. The operational all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroac~ents. ~,e, can therefore not'give any estimate of ho~ [0ng the sy.~ill c0fi/~kiii~:to meet the operational requirements of the Municipality and State. ~~ %'*.>~\ A:~! - a ~ 4?_ 03-1T-00 1~:45 F~OI~-CTE ENVIRON~/I~NTAL rsi,CT&E Environmental Services 561~301 T-850 P.OZ/03 F-§~4 CT.e'E Ret'.g 1001021001 Project Name/# LI P¢~nin Cllen~ ~ample ~ $. Hose Matrix Dr~inB ~r Ordered ~y PWt~ o Client P( ,# Prlnte(l l ~aTe/Tlme 03/17/'2000 1.6 02 Collected Dnte~im© 03/12/2000 13:00 Reeeive~ D~le~me 03/13/2000 10:05 T~hnicat Director Stephen C, Ede 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. # C)I ,.-%--~-~-1-~- ~zc~ \t 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner '/~ Lending agency Mailin. g address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ .5- 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev. 1/91) Front MOA Ir21 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 ¢isposal 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 flies 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~::~A/Jwow Address ~':::'. ~ ,~ o % EngineeCs signature Date So DHHS SIGNATURE //"'" Approved for ~E' ! p/~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additiona4 Comments 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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. Municipality of Anchorage R }~ C [~ IV E D ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAY 5 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (9~t)ic3f~-d~7~,~n(;norage oept. Health & Human Services Health Authority Approval Checklist Legal Description: A. WELL DATA Well Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to ~ Date of test Static water level Well production Parcel I.D.: IfA, S, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 1 17I' FROM WELL LOG '~" g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: ~'/'~/? ~ Collected by: B, SEPTIC/HOLDING TANK DATA'---~' ~ ¢ ~?~ Date installed //]~ / q Foundation cleanout (Y/N) Date of Pumping ,5~/~'/'~ C. ABSORPTION FIELD DATA Date installed Length ~ ~ ( Width Effective absorption area r' g.p.m. Other bacteria -- O ---"' Tank size [~ ~ Number of Compartments /-"( Cleanouts (Y/N) . Depression (Y/N) ~ High water alarm (Y/N) "~ Pumper ~ ''~ Soil rating ~orfF/bdrm) /,~ Systemtype ~-~L<~z ~ ( Gravel thickness below pipe '~ / Total depth Monitoring Tube present (Y/N) ~ Depression over field (Y/N) ~ Date of adequacy test ~"/~/~7 ?' Results (Pass/Fail) ~A s~ For ~- bedrooms Fluid depth in absorption field before test (in.); _ ~' Immediately after ~ gal. water added (in.): '~q ~' Fluid depth c~ (, (ins) Minutes later: ~c~{~.'t-'' Absorption rate = '~'~-~ g.p.d. Peroxide treatment (past 12 months) (Y/N) '~ ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* '-~'-2 ~/% Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ¢~///~ Sewer/septic service line Size in gallons "Pump on" level at* '-~'S'-tl *Datum ~-~[/'ct On adjacent lots On adjacent lots "Pump off" level at* z/,¥ ~ /~ '-~ Public sewer manhole/cleanout Lift station /~? z.// SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: //~(~)~V'ct LC Foundation '~-~ Property line ,~,S-~ Absorption field ~---~ ~ Wells on adjacent lots Water main/service line ~-01 Sudacewater/drainage / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -S¢ r Building foundation Surface water /O~ Curtain drain ~' C,o ~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~' ~'0 ~- F. ENGINEER'S CERTIFICATION I certify that I have determined in conformance with MOA HAA guidelines in effect on this date. Signatur~:~~ Engineer's Name -%;'q-L4~8.,,.a ~,~:~A~/UO~I ~ ~' Date ¢~-'/~' [ ~' ~. HAA Fee $ Date of Payment Receipt Number ~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number JtAY-OT-g~ 10:Z3 FROM-CTE ENVIRONi/~ENTAL CT&E ~nvireamantal 5615301 T-~?2 P.02/03 F-497 CT&;E Ref,# 99193300~ Client Name Pm-n%o~e Eng. P¥oJ e. ct Name/# k Client Sample ~ h t Matrix D~i~ing W~ter Ordered By PW~ Client PO/? PrilltOd Date/Time 05/(~6199 16:05 Collected Dat~/Time 05/05/99 18:30 R~aiv~ Dare/Time 0~/~/99 ] 3:05 T~hnical Bit.or: St~ea C, ~ Nitrate,~ 0,80~ 0,~00 mo/~ gPA ~00.0 10 rr~x 0~/0~/~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Or!=Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 01~:~- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (siteaddress or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: .-~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system; 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#25 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 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. NameofFirm --1c>/¢/~ ~)~'~'r~'~[~-¢~¢ ~'~J~ Phone Address ~-0 "~ ~ / z-/.-¢¢ Engineer's signature ~ Date DHHS SIGNATURE Approved for 5 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ?l'he M~h'!ci~)i~lity of Aflc'h0rage Department of Health and Human Services (DHHS) issues Health Authority ,~pproval C~tificates it~ased only upon the representations given in paragraph 5 above by an independent profess onal eng ncer reg stered in the State of Alaska, The DHHS does th s as a courtesy to purchasers of hornes and their lending ~nstitutions in order to satisfy certain federa 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. 724}25(Rev. 1/91) B~ck MOA~21 MUNiGiPALI'rY 0~ E'i.,JVIRONMENTAL SI~RVICE$ DIVI$ IL Municipality of Anchorage DEC 2 0 'i996~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division R E C E J V E 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: I-oT' [, "~ls,'~.~t,t,.L ~.'~m16H-~% ParcelI.D.: ~t~--- A. WELL DATA Well type Log present (Y/N) Total depth ~-~ ~ ~, f Sanitary seal (Y/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed '7/1~"/"1 J~ Cased to r~ i Casing height (above ground) ~,~ y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform ¢ Date of sample: I Nitrate Collected by: Other bacteria B. SEPTIC/HOLDINGTANK DATA Date installed ~l/z.& Foundation cleanout (Y/N) Date of Pumping Tanksize /~'~¢,¢J Number of Compartments ¢ Cleanouts(Y/N) ~'/ Depression (Y/N) ~.) High water alarm (Y/N) y Pumper ~t I ~ C. ABSORPTION FIELD DATA Date iostalled H]?'b ]~' ~' Length /~/~ I Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth ~/' (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) v/ Soil rating (g.p.d./fF-~r ft~bd,,~,) J ~' System type ~,~ I Gravel thickness below pipe f,~ ! Total depth ~ / /2Z'7~ Monitoring Tube present (Y/N) ~/__ Depression over field (Y/N) J'~ / ~'~ Results (Pass/Fail) ~'// For Immediately after '/ gal. water added (in,): Absorption rate = .g,p.d, If yes, give date d-// bedrooms 72-026 (Rev. 3/96)* ,MUNICIPALITY OF ^NCHORAC~I~ ENVIRONMENTAL SERVICE.S DIVISION DEC 20 1996 LIFT STATION Date installed I ~/,Z.-~/~' Manhole/Access (Y/N) \/ High water alarm level at* r¢ ~/~ Size in gallons "Pump on" level at* ~ ~' *Datum RECEIVED "Pump off" level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleenout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: Foundation ~ Property line '~,.~ Absorption field Water main/service line ?,,¢4~ Surface water/drainage ~)¢ ¢ 4L_ Wells on adjacent lots ~' /~'~:~ I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation ~ '~ Water main/service line Driveway, parking/vehicle storage area ~ Wells on adjacent lots ~ /g.o.~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the aboVe systems are Engineer's Name HAA Fee $_ Dateof Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 966562001 Tobhen Spurkland P.E. Lot 1 Peregrine H Lot 1 Peregrine H Driltking Water Sample Remarks: Client PO# Printed Date/Time 12/18/96 11:07 Collected Date/Time 12/13/96 I5:30 Received Date/Time 12/13/96 16:30 Technical Director: Stephen C. Erie Released By ~C Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N 0.100 U 0.100 mg/L SM18 4500-NO3F 10 max 12/17/96 EMB Total Coliform 0 0 co[/lOOmL SM18 92228 12/13/96 WEP