The URL can be used to link to this page

Home My WebLink AboutFRISLIE LT 7Frislie Lot 7 #014-162-35 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~/~1~ L I_ I-~OMt~ ~,ddress can ~'~.,~TO SEPTIC ABS0flPTION TANK FIEL0 WELL Pho.e(.) I Pe,mit No, NO. of WELL LEGAL DESCRIPTION LOT LINE Township, Range, AS-BU LTD AGRAM (Show location of well, septic system, prope~y lines, founaation TANKS ~ SEPTIC ~ HOLDING TYPE OF SYSTEM ~ T.E.C. ~ aEO ~ W. 0~*,~ ~ OT.Ea ~ ongina~ graae FT FI FT F1 FT FT ~OLSE 80 FT F1 / I I 8Q FT ' I WELL~ I I ~ PRIVATE ~ OTHEB (Identify) REMARKS: ~~ CO~TIO~ ~ Inspections Pe~ormed by: m~'"'"I~A~ ~ A .~6 ~'OM cmilytha~isimpe~onwaspefl~m~a~rdingtoall ~:, / aunicipal and Sim g.ideli.~ i. aim a lhls la~: / y7 ~ / Z /~ / 72-013 (3/85) Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 January 8, 1991 Spinnell Homes 9210 Vanguard Anchorage, Alaska 99507 Subject: Lot 7 Frislie Subdivision Permit #900361, PID #014-162-35 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-bull[ inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspect'ion reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, Sin~r e~y, ./ On-site Services please call this office at 343-4744° JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" :1 !,I::BTAL.[ I':'ED I'.41'Tf~C'HE:D .~ii;]:"l'E PLAN. ..,.Ji .t['t DI~,']~i F'RIOF~ T[) ANY ~l~ I.! L [.J~l. F}"I:[ F:'ERt'I]/T ]'S ]:S-~UE[) FOR THE F:'L~-~NNE:D 5 BDR~ t:~:lldl;l ~F"'l~ii,i" '~'' ~'' ~)UIi~iL_L..] NF; ....... :II',ILV (4hlI) IEiXP'[F~L::S E)I"~ ].~, ..,,, ], / ~"~ /":r ~",.-, .... i ~,.~, , . .,, ;.,: . ....~1 ....~, .......... ~ ~ i. '. ,~ ,. ,' '"!'~i'~ , , ~,~I,.q~ ........ ~ ~, ,, ........ , ' "' '"' " ~""'~il ' , I h*reby certif~ ~l,a~ I h~ve ~totmed d Hor~8~geete ~nuFe~ti. on of ~he g~llo~l.~ de,~ibed p~OFe~t~ ....... '; " do hoc o~e~lap or e.cro~ch on the prop6rty LOCATION OF WELL STATE' OF ' ' DEP2%RT~NT OF NATURAL RESO~3g~CES DXVXSXON OF GEOLOGICAL, ANO GEOPHYSICAL SURVEYS WATER WELL RECORD-, · BOROUGH SUBDIVISION LOT BLOCK SECTION QTR: ~ TOWNSHIP RA~NGE MERIDI~/g , 7 .. os' . DIRECTIONS:~l '~ I '~. ~AS~ING POINT: z~top of casing ~LL DEPTH: ~ DATE OF CO~LETION: ~ground surface ~other: .Depth of hol~: ft Depth of ca~lng//~, ft BO~HOLE DATA: Depth STATIC WATER ~L: /~] ft. Date/~/~L~/~ Material type and color From To ~ ~ ~THOD OF DRILLING: ~air rotaryV~ .~-~L~ ~)~ ..... / ~ ~ USE OF WELL:~d0mestic Slrrigation ~monitor -, / ~ K-~/ ~public s~pply ~ other: / '-:~Z-' / ~,.~i~ Z ~ CASING: Stick-up ~. ft. Diam: E~ in / ~/' 4 ' WELL INT~E:/~ open end ~screened ~ /~.~.-~ ~ ~-~- ~ ~· ~ perforated ~open hole ~ / ~ ~ Depths of openings: to ft SC~N~: ~a~= Slot/Mesh S~. L~ngth: ~ / Set Between__ and ..... G~VEL PACK Vol~e used: R ~ L k I V E D %~.~.~Volume: ~~AN1 41991 Depth: from -"--~ D~LOP~ENT ~ETHOD: ~ ~ · Municipality of Anchorage Duratio~: / Dept, Health a Human Services ~S: P~PING LEaL ~D yIELD: ..... ~ ft after / hrs pumping ~ gpm P~ INT~E DEPTH:__ft Horsepower: Date P~p Installed - CONT~CTOR INFO~TION: ~ ~m... ) ' / /~''/~/~,~ .... r~ Y Well disinfected upon completion? ~ ves ~no 'Regi~/t~red Business Na~ ~z/ ~ ~.~_~.../// . PLEASE MAIL WHITE COPY OF LOG WITHIN 45 ~.,-~ .,~. .- ,~ .~5.. DAYS TO: /~'~.. ~L_.. //~.~...~..~. Signature of Authorize~'Representative /f/-- / z/-.- ~:.~ Date DGGS PO BOX 77-2116 EAGLE RIVER, AK, 99577 N EAST ~£ LADASA 0 LAVERNE Plnce Pl~ce 41~R~ Z o_q (~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services (~'~4~,~I-. DIVISION OF ENVIRONMENTAL SERVICES 343-4744 "~." ~ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APJ~;~,VAL ~E~. ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY' ~J~L'~I,N_G Parcel I.D.# ~\~- ileal.- .'~-.~ HAA# ~ ~:~C~ ~C-~L.~c~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~,fOz~ E/~ Mailing Address q ¢-i O (c) Lending Institution Telephone: (home) Telephone Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here E~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms ~ 3. WATER SUPPLY ~' Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Depa~'tment of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL~- On-site [] Public I~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72~)25 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal aifixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval 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. Name of Firm 'Z~/'J~'/.$O~J Z-----------------------------------~G ~-~IZ~N (, Telephone ,~5'7- Address ~0. ~c~ .~. z.~/O 77..Y ,Z~ C,,~ o ,,L,4 Ge-' Date Engineer's Seal Approved. for ,,~-, bedrooms by Approved. ~/~ __Disapproved Conditional Terrns Of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 M unicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev, 7/88) Back Page 2 of 2 /~bi,,.~'J~j~NICIPALITY Of ANCHORAGE (MOA) t~'~J~t'~ ~) TM ~ Health Authority Approval (NAA) 1~t k~:?~i;~/ CHECKLIST - FEBRUARY 1984 ~,e?.~lt,~3S'iVtN'~V'8't"~l~ ''' Legal Description: /_~7" A. WELL DATA ' Well Classification ~'~'~ V, ATE.' ' Well Log Present (Y/N) ~/ Date Completed //-/~/-~0 Yield Total Depth 75/¢ Cased to 7f// Depth of Grouting A/o ~;o uT'/M ~: Static, Water Level /C~ ' 7'. Pump Set At ?~ ' Casing Height Above Ground Z ~/~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~V Depress on Around Wellhead (Y/N) · SEPARATION DISTANCES FROM WELL: .. To Septic/Holding Tank on Lot F'um&/C To Nearest Edge of Absorption Field on LOt ~/J? To Nearest Public Sewer Line ~/! ?' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ~.CF~, Water Sample Test Results Comments ~JE'L,L 15 If A, B, C, D.E.C. Approved (Y/N) ; On Adjoining Lots F'UB~/¢ ; On Adjoining Lot§ SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) Depression over Tank (Y/N) No. of Compartments Air-tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) To Water-S.upply Well To Property Line To Water Main/Service Line Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/881 Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field IY/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Type of System D~s~gn Length of Field Depth of :Fiel.d Gravel Bed Thickness Statndpipes Present (Y/N} Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ~/~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes IY/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (WN) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA~.ui~eJ.iDes in effeet, gn the date of this Signed ~ ~ ~ . ~.~'"'~'~.~',. Company ~0 ~/~C ~./.__ ~ ~ _ ~ ~ -- -- -- -- ~...~.ff,~,~...,..j.~ Engineer's Seal Date ~/~/ ~ · ' ~ MOA NO ....... ~ ,~chael E. Anaerm. · ~ ~". ~81-E Z~ Receipt No. ~/ ~ ~/ Receipt No. ~%%~ Date of Payment ~ -/~ - ~ Waiver Fee: $ Amount: $ /~ ~ Date of Payment ~2~26 (Rev. 7/88) Back Page 2 of 2 FEDERAL TAXI.D, #92-0040440 AMALgams BE?0~T B! 5J.I~L~ fo~ Work 0~der I 31808 Date ~epozt Printed: EES 8 91 ~ 05:53 Client Sample ID:L? ~I3LIE ~LL Collected YEB $ 91 a 13:00 ~ecelved ~BB S 9] ~ ~3:15 b.~s. Preserved ~lth :AS i~EOUI~D Chant ~aae : MCPADDEN, WAYN~ Client Acct BPO t PO ~ NONE RECEIV~D ~eq ! Ordered By knalysls Completed :FBB 6 91 Send Reports Chemlab ~ef t: 910392 Lab ampl ID: t ~trlx: MATB~ Allowable ?eza~etez Tested ~esult Un, ts Metho~ Limits NIT~A~B-N ~(0.10) ~/1 ~P~ ~53.2 10 3enple ~0~I~ 3AI~LB COLL~CTBD ET: MC~ADDEB. I Tests Pe~iormed ' See Special Instructions Above UA-Unavetlable MD- ~one Detecteg "~ea ~emple ~emarke Above MA- ~ot Analyzed LT.Leee Than, 6T-~zeate~ Then