HomeMy WebLinkAboutHULSE #3 LT 11
!' ~ MUNICIPALITY OF ANCHORAGE
. 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 PHONE ,~NEW
o f7
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ ~ C Absor~i~ area Dwelling PERMIT NO.
~ ~ Manufacturer Material No. of com~rtments
Liq. capacity in, Ions Inside length Width _ Liquid dep~
/~O O I F HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
Nearest ]or line PERMIT NO.
Q Well Foundation
~ = DISTANCE TO: /~ /
~ ~ ~ ~rench widt~ , Distan~2~ween lines
~ ND. of lines Length of each li,e Totallength nes ~ ~ -
-- Top of tile to finish grade Material ben~at~ tile Total ~ffective ab~rption area
Length Width Depth ~ERMIT 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.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
~-~0FESS~ J ~. ~ ~
DEPARTMENT OF HEALTH AND ENVIRONMENTAl_ PROTECTION
82::!5 I_ S]"REE'T', ANCHORAGE~ AK 99501
264-4720
F:'EI:~:M I 'T NO:
DATE I .... d..Jl] .L .
AF::'F"L. I CAN'I":
ADDRESS ::
CC}NT'AC'T' PHONE'::
L..IEGAL DIESCR I P:
L., E)"F S I Z E :~
MAX BEDRDOMS:
SCO]'"F & KAREN HUL,.SE
1:::'. 0. BOX 773946
EA[:.)LE RIVER, Al'::: 99577
694-2466
SUBDIVIS]:ON.-. HUL. SE 3RD ADD.
SIECT I ON: 2'.3 TOWNSH I F' ,", 14N
46254, (SQ. FT. [:iR ACRIES)
3
L.OT." 11 ELOL,I... NA
l...isted below ar'e the opt:i.c~r"~s available 'Lo you in design:i, rtg your sep'L:i,c
system. Choose the Ol:)ticm that best. Fits your site.,
DEI':"I'H "FCI PIF::'E BO'T'T'OM (FT;.)
GRAVEl... DEPTH (F:T.)
TOTAL DEPTH (FT.)
GRAVEl._ M].'DTH (F::T.)
GRAVEL LENGTH (FT..}
GF:;~AVEI.... VOL. UME (CLI. YDS,. )
T~NI< SIZE (GAL, S)
SOIL. RA]"INB (SQ,F]'. /BF;:)
¢~"~' "f'AI'4K MU,~S'I' HAVE A't' I....EAS'T' I~(.l CEIMF:'AR"IMENTS
]: c:er'tiJ'y that:
:L, I am {'ami].:i. ar' ~:L't.h 'Lhe r, equ:Lr'emer'd:.s for' (:~n.-.,,site sewer's anti wells as set
¢or'th by the Idunic:il::)a].:i. ty oF Anchopage (MOA) and the State oF Alaska.
2.: I wi ]. 1 ins'La].:I. 'Lhe system :i.r'~ ac:cor'danc:e w:i.'bl"~ al ]. MCIA Eodes and ret:du,l, ations,
and in compl~ance~ w:Ltl"l the des:Lgrt cr, iLer:i,a o¢ this pepmit.
7.;., I will adhere to all MOA and State of' Alaska requ:Lr, emerrt, s for' the set bac:k
dis'Lances f'r'om any existing we:l.l~, was't:.e~,gat, er ctisposal system of publ:Lc:
~;(.:~Nepag~) !~;V~t,(~¢t] c)n '(.his op Ed]y adjac:errL OP near'by lot.
4,, [ L.tf'ider'stand that '[.his per'mit :i.s val:i.d {top a fftaximLt~l oJ' 3 beclnooms ar'id
any enlaPgemerrt:, will r, equJ. pe an add:i, tic)na], per'm:i.t..
IF (~ L. IFT STATION :IS INS'I"AI...L. ED IN AN AREA COVERED BY MOA BLJIL..DING CODES,
"f'HEN (1) AN ELEC"I'RICAL,,. PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL.. NOT 'BE AI::'F'ROVED WITHOUT AN EI.,..ECTRICAL, INSF'ECTION REF'ORT; AND (3) THE
ELECTRICAL, WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
All'PI_ :[ CAN'1": SCO'T"I" & KAREN I'"ILJL. SE
1 .~,..~ U E D D A T E ~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
~--~.~?~ .~ ~o^~¢ ~-~- , DATE PERFORMED:__
LEGAL DESCRIPTION: ~-~o 7~ // /~7/~ /s~ Z~ A~,Township, Range, Section: ~-/~/'/>' ~ / w ~r ~ c ;:::JL ,?
6 - r2- o
9- ~o~'
~'0' ~
12 ' ¢ ~
14-
15-
16-
17-
18-
19-
20-
/5'-O
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT /.~/ O
DEPTH?
Depth Io Water Altering?,_.' /~/i/~/o~_
~ ~ MonitorinD? Date:
~ ~o1~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE /J"'~' (mH~_es/irmh) PERC HOLE DIAMETER __
TEST RUN BETWEEN __ FT AND __ FT
COMMENTS
P. 0, lt0x 773294 I -.,~~' CERTIFY THAT THiS TEST WAS PERFORMED IN
PERFORMED BY: ~Ea§le RiV~ Al( 9~577 ~ ' ~,/./
ACCORDANCE WITH ALL STATE A~',~I~NICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:,///~./~ ~--