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HomeMy WebLinkAboutMINDYER MANORS BLK 2 LT 4Mindye Manors Block 2 Lot 4 #020-091-71 DATE,SCHEDULED- ,, ,.. TiME .... , . iNSPECTOR : ~,Jj ., . . · , , . ~ , . :. ~?URDIVISIoN,.. MINDYER MANORS,_," -' ,,. ,~ :. :' ":. :.,BLOCK/LOT/TRACTBLK 2LT 5 .., · ,~ ."..~..'.: . . ,, . : ' '..,',:, : . .' ............ ,.: ~,,",~' . . . . .-~:-~_..---.~--,-~ ~-~-..~ ~.--.~-~-- ..... .---.-~...~ : · .... .-, ..... ,., . r ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ~ 825 L Street -, Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IP'DNE J NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ ~ Manufacturer Material No. of compartments Liq, capacity in gallons Inside length Width Liquid depth Z~ ,,7 IF HOME~DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O z ~ Manufacturer Material Liquid capacity in gallons Q Well I Z~oanda~ c.n f ~' ~earest lot line ,; PERMIT NO. T6~al of lines Trench width Distance between lines No. of line? LengtSo~ach line. length ~ Topoftil. to finish ~rado ~ M~toria~oneathtilo ,, ~ inchos Tota, effeetiueabsorptionaroa Length ~: Width Depth PERMIT NO. ~ ~ Type of crib Crib d~ameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT ~ Building foundation ~ Sewer line Septic tanE Absorption area{s) ~ DISTANCE TO: OTHER I PIPE MATERIALS ~C/~/ ~ ~.0 SOIL TEST RATING ~ ~ INSTALLER ~ ~:~ ~:-:.: .: ~ ~. ... . ~.~ .... ,~ ~ 72-0~3 (Rev, 3/78) MUNICIPALITY OF ANCHORAGE Department o~ Health and Environmental Protection 825 'i Street Anchorage, AK. 501 *L~C*3.]UA~J~TTEN PERMIT * * * Pe~it ~ w,~N-SITE SEWER PERMIT~~ T~e of Soil ~sorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: ~ximum N~Eer~ of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: ' / % DEPTH /~> LENGTH ,~,~ GRAVEL DEPTH ~ · WIDTH JCl The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches° The gravel depth is the minimum depth of gravel between the outfall pipe and bottom of the excavation(in feet). the * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will. be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet° Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31. 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage° (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more th~ bedroo~ Signe~: C4 /~,/)?~-~2' ~- Issued by ~plicant ?' Date: ~.~I SWP/024 (1/81) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~-~-~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NA ~HONE ~ING ADDRESS~ ~. LO~ATIO~ ~0, O~ BEDrOOm8 [Well Absorption area~ Dwelling Z--- ~ ~ DISTANCE TO: / O ~J / ~ '~ ~ ¢ PE ~ ~ Manufacturer/ ~ Material... __ · No. of~mpartments Liq. c¢9acity in gallons Inside length Width Liquid depth /~5~ IF HOME'DE: ~O ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ Manufacturer Material Liquid capacity in gallons ~ We]l/~ ~ Foundation Nearest ,o~ PE~IT NO. ~ ~ ~ No. of lines . Lenqth of each line Total ?ng~ ~, l,~es T~nc~,i~h Distance~t~n lines ~Z-~: / MaterialLen~htilo~ ,~ ,¢) ,riches --~' (finish grade Total effect'~;¢~ti°~:sa ~ Top of tile , Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ ~ DISTANCE TO: ' Building foundation Se~er li6e SeptiCt~ ~ ' Absorption area(s) OTHER P. IPE MATERIALS, SOl L TEST R~N~_.. 72-0?3 (Rev. 3/78} ~ ~ MUNICIPALITY OF ANCHORAGE -'~' De artment - Health and Environmenta? ~rotection ~i-j~ ' ~ ~ · · 825 '~'--~/ Street, Anchorage, AK.~ .... /501 < ~..~ ~ ' ' - 264-4720 ~ "~ / ~O© ,~' ~ .~ , ,~ * * * HANDWRITTEN PERMIT * * * \ ~ ~.~ £~/~ Permzt ~ ~ O ~ WELL ANJ]/OR ON-SITE SEWER PERMIT ' ocation: hone u er: Type of Soil Absorption System Is: Trench: L/ Drainfield: Seepage Bed: HOlding Tank:C- umber of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil kbsorption System Is: ' DEPTH /~. LENGTH ~ .. GRAVEL DEPTH ~ WIDTH· The length dimension is the length(in fee~) of the trenoh or d~ainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for t~enches. The gravel depth is the minimum depth of gravel between the outfall ~ipe a~d the bottom of the e×eavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~Q~ GALLONS * * ~ermit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. *** · * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if · the residence is remodeled to include more ~ .bedrooms. sign~d:~~ ~ ~--~/ Issued by:~ ~ ~pplicant Date: Y SWP/024 (l/S1) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99601 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~'~(~ 2 3 4 5 6 7 8 9 SITE PLAN SLOPE WAS GROUND WATER ENCOUNTERED? E 12 IF YES, AT WHAT DEPTH? 13 14 15 16 17 18 19 Gross Net Depth to Net Reading Date Time Time.~.~ ~e,~i~[~ri~, ,~ ,~ Drop 20 (minutes/inch) PERCOLATION RATE ~ TEST_I~UN BETWEEN , FT AND ~ FT 72-008 (6/79) { tv1-W DRILLING, Inc. P.O. Box 10378 * 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 84-174 DRILLING LOG W'e]l Owner BREX,~i, BTLL & CARACg .UseofWe]! Location (address of: Township, Range, Section, if known; or distance main road Lot 4 Block. 2 Mindyer Manors D(m~s tic Size of casing Static water leve] Screen ( Depth of Hole 9 ft. ); Perforated ( Describe screen or perforation Well pumping test at 21 gallons per of drawdown from static level, Date of completio~ ~a,~ 3, 1984 225 feet Cased to 38.50 feet (below) land surface. Finish of well (check one) open end ( X (m~ for 1 hours with 100% WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness Cas stickup ); 0 .TO 2 TO 15 .TO .. 34 TO TO TO .TO TO. TO. TO TO. TO .TO TO. .TO. 2 15 34 225 Dray ,silty Gravel " ' 3--CONTRACTOR M-W DRILLING, Inc. 'q ?.O. Box 10-378 · 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 Revised Log: Prom 83-256 To 84-165 DRILLING LOG Well Owner BTT.T. & G~AC~ B~ Use of Well ~esttc Location (address of: Tow~hip, R~ge, ~cfion, ff ~o~; or ~st~ce ma~ road ~t 4 Blo~ 2 ~ ~or S~~ Size of casing 6" DePth of Hole 360 feet Casedto 37.5 feet Staticwaterlevel --E tr. ~ (below) land surface. Finis~ of wen (checkone) openend (xxx); Screen ( ); Perforated ( )~ Describe screen or perforation None We]] pumping test at 7'. gallons per (~z~ (a~l~) for ,-~ of drawdown from static level. hours with 100% '- ~ Date of completion ~ptember 23. 1983 ~Well Deepened May 2, 1984 WELL LOG Depth in feet from ground surface Giv~ details of formations penetrated, size of material, color and hardness Casing stickup 0TO 2 2.TO 4 4 TO .10 = 10 TO. 12 12 TO. 18 18 TO 24 24 TO 30 30 .TO 33 33 34 34 TO 300 300 TO~ TO_ TO. ,TO Org_ard_cs Graval-& clay'. Clay with sand GYavel clay. GraVel~-clay' Fractured 'bedrock Bedrock with small wa~er seeps in sporadic fractures Rt~_d'r'o~k ~ertificate J~/o'e e, ,". ctor 1--CUSTOMER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage;AK 99519-6650 _ . · www.ci.anchorage.ak.us (907) 349-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ' 020-091-71 1. GENERAL INFORMATION Expiration Date:, Completelegaldescription MINDYER MANORS SUBDIVISION: LOT 4~ BLOCK 2~ t,,~s~e address or,. ,,.~ ,Mire~inns~ 4640 ~RCO AVENUE · ANCHORACE~ AK 99516 Lo~fion Current Property owner(s) Mailing address Len. ding agency Mailing address Real Estate Agent · Mailing address GRACE BROWN Dayphone 4640 ~RGO AVENUE · ANCHORAGEI AK 99516 DayPhone 3~5-7439 TERRY PISA w/ 0YNAMIC PROPERTIES Day phone 3111 "C" STREET · ANCHORAGE. AK 99503 261-7600 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3, TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage r~ Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 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 vedfy that my Invesfigation, based on procedures outlined In the Health Authort~y Approval Guidelines for this application, shows that the on-site water supp~, and/or wsstewater disposal system is(are) safe, functional and adequate for the number of bedrooms and ~/pe of structure indicated herein. I further verify that based on the Informab'on obtained from the Municipality of Anchorage files and from rny Invesb'gation and inspecb'on, the on-site water suppfy and/or wsstewater disposal system Is(are) In compliance ~th all applicable Municipal and State codes, ordinances,' and regulab'ons In effect at the b'me of lnstaliafion. Name of Firm. "ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineers Printed Name JEFFREY A. CARN£SS, P.E. Engineer's Comments: In conducting thl~ evaluaE<~, AWWC, Inc. e~lempted to provfde a thorough, consdenti~us engineering analysis of the s]~tem In accordance ~th ADEC and MOA DSD Guidelines & Rugula#ons. The reported results desc~7~ed the perf~rnance of the system under the conditions encountered at the time of the test, and separation distances measured to readiO/ Identifiable features° The opera,one/life Of all wells and septic sTstems depend on the local soils condition, groundwater levels that may Jluctoate during the ~ear, and the water usage of the faml~ being served by the system. These conditions are outside the con~l'ol of the e~aluato~ of the system. Satisfactory test results do not guarantoe fulure podon3qance of the sy'~tem, horde they guarantea that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provldo any wan'anty or future estimate of how long the systera v~l! continue to meat tho operational requirements of the ADEC or MOA DSD. The content ef this ~ep~t is for the r~le benefit of the owner listed above. Any reliance upon or use of this re~cx:~rt by any other peraon or pan'y ls not authodzed, t~or wlil lt confer any legal right wha~seaver. DSD SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date ~//~1 ON-SITE WATER AND : = WASTEWATER · PROGRAM · bedrooms, with the Illowlng stipulation~ <::)^.... .'" ~,,.~, ~,~l -"~ '"'"-' '"' Attachments: HAA Checldist Septic System Advisory Well Flow Advisory By: ~'",.-'"' ff~. ~o) Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety OMslon On-Site Water & Wastevmter Program 4700 6oulh Bragaw SL P.O. Box 196650 Ancfl~age, AK 99519-6650 www.ct.enchomga.ak.us (907) ~3-7904 HEALTH AUTHORITY APPROVAL CHECKLIST MINDYER MANORS S/D; LOT 4. BLOCK 2. *CASED TO BEDROCK Legal Description: A. WELL DATA Well type PR~V^TE: IfA, B, or C provide PWSID# N/A Wall Log (Y/N) san=r, s., (Y/N YES Wlro. pro... (Y/N, .360 '57.5 Total depth 225 lt. Cased to *38.5 ff. Casing height (above ground) FROM WELL LOG AT INSPECTION 9/25/83 Data of test 5/5/84 9/6/00 9 42 Static watar level 9 ft. 65 fl. 0.12 0.08 Well production 0.35 g.p.m. 0.06 g.p.m. 500 GALLONS OF WATER WATER SAMPLE RESULTS: STORAGE ADDED Coliform 0 colonieaJl00 mi. Nllrata 0.5 mg./L. Other bectada Data of sample: 5/7/2001 Collected by: AWWC, INC. Parcel ID: 020-091-71 YES YES 18+ ~. 0 colonies/100 mi. PUBLIC B. SEPTIC/HOLDING TANK DATA Tank Type/Material Data installed Tank size gal. Number of Comparlments ~¢~'~ Found _etlon d?a~ (Y/N) High water alarm (Y/N) ~Pumper C, ABSORPTION FIELD DATA SEWER Data installed Soil rating (g.p.d./it~or ft;/bdrm) System [ype. Length It. Width It. Gm~~p~'"~- fl' Total depth ff. Eft..bsorpUonarea It' Mo~,~ Depress= over~eld~_ Elapsed Time: · . Final fluid depth in. Absorption rata >= g.p.d. ~atment (past 12 mo.) (Y/N & type) If yea, give data Cycles tested. Meets alarm & drcult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots 100' + On adjacent lots 100' + Public sewer manhole/cleanout Holding tank Septic tank/tiff station on lot N/A Absorption field on lot N//A Public sewer main 75'+ Sewer/septic service line 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: P U B L IC Building foundation Property line Absorption field Watar main . ~ Wells o 100'+ SEWERS SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~Bulldlng foundation Water main ~ Water service line ~y, parking/vehicle storage ~ Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end rm4ew of Municipal records that the above systems are in conformance wfth MOA HAA guidelines in effect on this date. Engloeel's Pdnte/d ?me JEFFREY A. GARN£$$ oeta HAA Fee $ Date of Payment ~' - I I .- O / Receipt Number (Rev. 12m0) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEI~ARTMENT OF HEALTH AND ENVIRONMENTAL PROTracTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date_ 7/5 iegal D~sc~iption ( include lot ~ block, subdivision, section, tc;~nship, ~*ange ) " " ' Lo~tion (ad.ess o~ directions) / Applicants N~ ~.~/.~'~. ~~ '~ l~¢ ~.,~ ~c) -:~ ~" .... Applicants Ad.ess ..~:,~ ~'~ ~,~'~' ~f ~- ~ ~ ~' Applicant is (che~ o~) ~nding Institution ~; ~er~uil~r~[-; Bu~ ~ ; ~he~ ~ (e~lain); ~nding Institution ~ Teleph~:~ ~.::," / Ad.ess .... ~: >c :~ d~: ~/~ ~al Estate Co. & ~ent_ ~.~ ~,c~+ Ad~,ess (a) (b) (d) (e) Telephone 2. :'ype of Fesidence Single-Family Number of Bedrcoms 3. Water Sqpj2~ Individual 4%11 Other (des~i~) Community E~ Publie ~-~ Note: If community %911 system, must have w~itten confirmation from the State Department of Envirop~rental Conservation attesting to the legality and status. Is t>,e %911 adequate for the number of bedrccms specified in this HAA (Y~) ~sposat Onsite ~ Public E~ Cormaunity ~ Holding Tapk Is the wastewate= disposal system adequate fo~ the pnmbe= of bedrooms (Y/N) [Page 1 of 2] 2-15-84 5. Engineeninq Farm P~ovid~in9 Inspections, Tests, Data and Information I certify that I have checked, venified, c~ conforra~d to all MOA HAA Guidelines In effect on the date of this inspection° ) ¢~-%~'fl7 +k~+ Signed ~ Date 6. DHEP ~43Droval Approved fo~ Approved ~ ( ENGINEER SEAL) ~ bedrcoms Disapproved Terms of Conditional Approval ~he Municipality of Anchorage Department of Health and Envi~onn~ntal Protection dces not guarantee the continued satisfactory pe~fom~ance of the wate~ supply and/or the wastewate~ disposal system° ~nis approval indicates that~ as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the waten supply and wastewate~ disposal system is safe and func- tional fo~ the numbe~ of bedrocks and type, of structure indicated° (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 ae MUNICIPALITY OF ANCHORAC~E DEPT. OF HEALTH & ENVIRONMENTAl- PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUthORITY APPROVAL (}{AA) CHECKLIST - FEBRUARY 1984 Legal Description: CEIc ,ED WELL DATA ~/o':/,,.~- ~. /'*//~/D '/~/~ //l~4//) ~ ~ ~ll ~ ~e~nt (Y~) ~& ~te ~eted ~3~X- .~/g~ Yield Sanit~y ~al on Casing (Y~)~ Casing Height Above Ground ,~, ~ Electrical Wiring in Conduit (Y/N) ~ SeParation Distances f~om Well: To Septic/HOlding Tank c~ Lot ~' ~ To Nearest Edge of Absorption Field on Lot/~9' ~ To Nearest Public Sewe~ Line ~/~ Cle anout/Manhole ~ ' Water Sample Collected By ///-/~/~/o/ Water Sample Test Results ~ C~ttt~nts Depression Around Wellhead (Y/N)~O d ; On Adjoining Lots /d969' '~' -i" On Adjoining Lots /..~D"~ To Neszest Public Sewer To Nea=est Sewe= Service Line on LOt ~-' ~- ; Date ~ -//7/- ,~$Z'_ B. SEPTIC/HOLDING TANK DATA Date Installed /69- 2 ~ ~ Size /~5) ~/?~ No. of C~,ga~h~ents Standpipes (Y/N)?(o~ Air-tight Caps (Y/N)~S Foundation Cleanout (Y/N)~'~ Depression ove~ Tank (Y/N)~ Date Last Pumped //63{.O Pumping/Maintenance Contract on File (Y/N)~/~ ; for ~q///~ (Y/N)/V~ Holding Tank High-Water Alarm (Y/N)~//~ /Temporary Holding Tank Permit ./ separation Distances f~om SePtic/Holding Tank: ,., To Wate=-Supply Well /6~9'~' To Building Foundation ! To P~operty Line j ~ 4 To Water Mai~Service Line c~~ ! ~ To Disposal Field ~ t To Stream, Pond, Lake, c~ Majo~ D~ainage [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~-~"?~'/ Date Installed ~/_~o/~,-/ Width of Field ~ Square Feet of Absorption A~ea 4~ .~Z Type of System Design Length of Field Depth of Field _..// / Gravel Bed Thickness Standpipes P~es~nt _(Y/N) Depression over Field (Y/N) ~/~3 Date of Last Adsquacy Test ~.~t/3 Results of Last Adequacy Test ~J~IX~ ~/~.~f'"? Separation Distanc~ f~om Absorption Field: To k~ate~-Supply Well /~' ~' To lhzoperty Line To Building Foundation /~' To Existing or Abandoned System Lot ~/~ ; On Adjoining Lots To Wate~ Main/Service Line ~'~' To Cutbank(if present) To St~eam/Pond/Lake/c~ Major D~ainage Course To D~iveway, Parking A~.ea, o~ Vehicle Sto~age A~ea Cora~ents/q~ ,m~¢ ~,a~ ' ' . _ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes.! Y/N) M~ets MOA Dimensions Manhole/Access .! Y/N) "Pump Off" Level at Vent (y/N) Pumping Cycles du~ing Adequacy Test. Comments ** Check Permitted Bed~,ccm Rating A~ainst HAA R~quest ** I certify that I have checked, verified, o~ confo~msd to all 5~A HAA Guideline~ in effect on the date o~ t~is_ ir~pec~,il~n. ~,~,?:C~::: A }' '~ KB1/d5/s [Page 2 of 2] 2-15-84 NHAWTHORNE-ENGINEERING June 20, 1984 Mr. Keith Bandt Anchorage Dept Health & Environmental Protection 825 "L" Street Anchorage, AK 99501 RE: Lot 4 B5 Mindyer Manors Dear Keith: Enclosed please find a letter to Mrs. Grace Brown and explaining the on-site waste disposal problems on the above lot. #1 shows the problems we discovered during our HAA inspection. NHAWTHORNE ~ ENGINEERING 7127 Old Seward Highway Anch., AK 99502 344.- 4711 two sketches Site Sketch Site Sketch #2 shows site characteristics per my survey of the property and my proposed design for a system that will solve the above separation distance problems. You verbally approved the plan on the telephone this date. Please make your comments and indicate your agreement below. Nell Hawthorne P.S. Mrs. Brown will still need a permit for Well #2 N HA WTH O R NE-,E N G INEERIN G m,~TIC BOULEVARD ALASKA 99503 June 20, Z984 Mrs. Grace M. Brown 3520 Evergreen Anchorage, AK RE: Wastewater Disposal System RelocatiOn Lot 4, Block 2, Mindyer Manors Dear Mrs. Brown: NHAWTHORNE , ENGIN~ER:NG 7i27 Old Seward Anch., AK 9950~ This letter and the attached two sketches show the separaration distance and installation errors we have found with your septic system during our Health Authority Approval and my propOsed reconstruction. The Municipality Department · of.Health and Environmental Protection has verbally approved of the reconstruction plan. Site Sketch~#2 dated June 20, 1984 and the following notes must be used for construction and inspection. Notes: 1. Leach field shall be installed in Native soil equal to soil shown on 4/22/81 soils-log for the property ' ("Well graded gravel and sand") 2. Existing leach field gravel shall be completely excavated and removed. Backfill. for the existing trench shall be a sand/silt mix, imported, if necessary. Backfill shall be compacted to 90% maximum density in 12" lifts. 30% Silt min. 3. Existing trench gravel shall not be reused unless washed to remove all sands and silts. Engineer inspection required. 4. Construction inspections shall be more comprehensive than typical to insure correct separation distances and placement of trench materials. The contractor shall be responsible for giving the inspector 24 hours notice prior to inspection of the following stages of construction. Inspections shall include: a. Existing system excavated, trench backfill on-site; tank removed from existing location. b. Backfill partly completed in existing trench. Backfill shall be sand/silt mix (30% min. Silt) Observe proper compaction techniques. c. Building outfall line, cleanouts, and tank in place but not backfilled, check tank distance to wells, CMP around cleanout, and bedding for pipe and tank. d. New trench excavated toelevation sho~. Check distances to wells and cut bank. Check trench sidewalls. To be GP/GW. Trench gravel on-site. Check quantity and type. Check for sands or silts if existing gravel is to be reused. e. Watch gravel being placed in trench. Insure that 4" "Sump" extends to bottom of trench (perforated below field pipe). f. Gravel bed leveled and field pipe installed. Clean out and sump connected. g. Gravel. installed 2" above pipe. Proper Silt/Sand barrier installed above gravel. · h. If trench or tank will have less than 4 ft of cover 2" DOW SM or equal shall be installed above, and shall be inspectedl t. Backfill completed and site grading complete. Shaped to divert runoff from all pipes and tank. All construction and inspection shall be in accordance with Municipality of Anchorage Department of Health & Environmental Protection permit for construction of the wastewater disposal system. Sincerely, Nell Hawthorne N HAWTH O RNE-EN G INEERIN G June 20, 2984 Mr. Bill Lamoureaux Alaska Department Environmental Conservation 437 "E" Street Anchorage, AK 99501 RE: Lot 4 Block 2 Mindyer Manors Dear Bill: Please consider this a request for waiver of the from a sewer cleanout to a residential well. The enclosed sketch of the property shows an existing moved (it has not been used) and the proposed new installation. are within the 100 ft. radius lines as shown. I feel that with proper inspection of the installation, designed, sufficient well protection will be provided. Neil Hawthorne BOULEVARD ALASKA 99503 NHAWTHORNE ENGIN EEp, iNG 7127 Old Sev,.'arJ i-!cu;~.,, ,- Anch,,. Al< 99502 344 .. 4.7 ~; separation distances system to be Two cleanouts as it is