HomeMy WebLinkAboutHULSE #3 LT 13
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONNIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAI LING ADDRESS
EGAL DESCRIPTION
.ONE I a .Ew
LOCATION , NO. OF BED.~..OOMS
Well Absorption ar6Ca Dwelling P ER M IT..~_ O..
~ ~ ~ Manufactur.er Material~, No. of compartments
~ Liq. capacity in gallons ~ ............ ~ Inside length ~ Width Liquid depth
' /ooo / .............. : I I --
~ ~ D STANCE -~ _~11 Dwelling ~ PERMIT NO.
~ ~ z I ' ~ [ / ~-'h I ~ ~% ~-' ~'~ --~-~--'
O z < I Man¢~rer~ '{ / {' / [ ~teria~ 'ki~capacity in gallons
O [ [ Well - Foundat on r I Nearest lot line PERMIT
~--O~ ~ DISTANCE TO: I ~)~ % /~J ~ ~' I ~ ~--~ ~ ~'~
~ ~ Z No. of Ih%es_ ~ ~ Length of each [ne Total length pf. lines Trench width Distance between lines
~ ~ I Top of tile to finish grade ~ Material beneath tile -- ~¢ I Total eff~ctiv~b~rBt~n area
I Length 'Width Depth I PERMIT NO.
~ * Type of crib /-Crib $amete= / ~ dep~ Total .ffe~b~ion area )
~ / WeIIL% Building fo~ ~earest lot line
'OlSTANCE TO:
¢1~ ~ * Depth Driller Distance to lot line I PERMIT NO,
~ I DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
I
OTHER
PIPE MATERIALS
SOIL TEST RATING
I NSTA ~L~R~
REMARKS
APPROVED
DATE LEGAL
[:, E F' FI F.¢, T M E N 'T,' O F H E: R L TH Fa N [:, E ~. t',.,' I F~' L' ~.! H E N T q L P R O T E C T Z O N ,: .? ..... , ." """"P"-"-T FINC:H, ORF~GE., RI':::. '3 ?~
F'O E:,-;; SEEL ER
LT. t3: HUL. SE S,,'D 3RD. RDDN.
¢ ~:' '1 ~'t'"':~ 'r F,'-FFF./T EL HULSE
I.':':'F¢"ICN MI 6 ER RE:,
L E 3FIL
SIZE '.t.:~.;27.~:,I..F.;(;!UF~:E FEET
T"¢F'E OF ':: ........ C !'[ FtE:SORF'T i Cff.,l ': VqTr:hl,. .,..'" :," ....: . R~:NC_ H
t,1.¢:t;:.::Z.~,l.I...If,! NLIME:ER OF BEDROOME; = :2:
SOiL R,.41ING
"FHE ~'=P_IDE[':, SIZE OF TFtE SOIL. F~,E:S;OF-?TIC!N ......... iS
· . ~: .......Ei~ ~:',". ~::'~ %"~ E'.": L. E::" EkE: IP -~.- ~ == ~
THE LENGTH DIMENSION tS 'THE LENG'!'H ,::IN FEE'T.':, OF' 'THE 'TF;.'.ENCH OR DI:;.:FIINFIEL.[>.
THE DE'PTH OF R TRENCH OF:! PIT IS THE: [:,IE;TRNCE DETHEEN THE :SLtRFF~C:E OF THEE
GRC)UND F.1N[':, THE BOTTOF1 OF THE Eh:CFtVFITiON ,.'.IN FE:ET).
THERE IS NO 'SET HIDTH FOF: 'TF.:ENC:HES.
THE GRFI',/EL DEPTH IS THE MINIMU?1 [:,EPTH OF GRFIVEL BETHEEN THE (]LITFRL..L, F:'IF'E
f~f',l[:, THE BOTTOM OF THE: E:4CF¢,/RT!ON <!N FEET).
F:'ERM I T MF" -F'.. L.. t.."""RN'*I HFIS THE; REqP. .........." t'.lq ]' E: I 1 I TLC TO INFORM 'TH t S [:,EPF1R'TMENT [:,UR I NG THE
I NSTFILJ_FI'T'I ON '[ NE F'E-'F'[ Z N'S OF RNh.' HELL..S Flr',:rFI:: ENT TO TN I S F'R 3F'ERT'¢ RND THE
NUMBEER OF RE:E;IDENCES THFIT l r-L: HEL. L HILL .:,[:.F.E.
PIIF,IIMLIM [:.'ISTFthlCE BETHEEN R H. ELL RND f:IF,t'¢ ON-SiTE SEHhaGE DISPOSRL. S?S'TEM IS
iOEi FEET FOR. f:t PRI'v'RTE HELL OR :.1..5~3 TO 2C1E'i FEET FROM Fl F:'UErL. IC HELL. [)EF'ENE:,ING
UF'ON THE TYPE Cfi:' F'UE~LIC: HELL,
MINIMIJM I)IS'TFaNC:E FROM R F'RI'v'FCFE HELL TO Fl PRI',,,'FITE SEHER L. INE IS 25 FEE'[' F:¢',!E)
'TO F:l COMMUNiT'¢ SEHER L. INE tS 75 FEET.
HELL. LOGS.; RRE REQUIRED FINE:, MUST BE RETURNED TO THE: DEPF~RTMENT !.,.tZ"E'HZI'.4 3E~ DFlh.'S
OF THE HEL. L COMF'LETION.
OTHER REQUIREMENTS MFY.r' RPPL'~/. SPECIFICRTIONS RNC, CONSTRUCTION DIFIGRFaMs iaF4:E
Ff',/R.T. LRE.-'LE TO INSLtF.:E PROPER ZNSTRL..LRTION.
I C:ERTIF"r' THF!T
:I.: I FIM FFfMILIFIR HITH THE REQUIREMENT'S FOR ON,SITE SEHERS faNE:.` HE:LL.S ]:IS ::.:.;ET'
FORTH B'.¢ THE MUNIC:IF'FIL. IT'T' OF RNCHORRC~E.
2: t HIL. L INSTRLL THE S"r%TEM IN FlCC::CFFE'.E:''RNC:E HITH 'THE CODES.
3: I UN[)ERSTRND THRT THE ON-'SITE SEHER S'¢S'f'EM MR? REQUIRE ENLRRGEMEF,FF If:' THE
RES tDENC:E IS REMODELE[:, TO I NC;LLtDE MORE "['HRN 3 E:EDROOMS.
CONSTRUCTION TEST LAB
"One Test is worth a Thousand Opinions"
2204 Cleveland Anchorage, Alaska 99503 277-0231
Perfo~ued for Mr. Max Hulse
Legal Description: Lot - ~3 .Block
This Fo~m reports: SOILS TEST YES
Date Performed 03-19-80
SubdivisionHulse Sbdvn $2 Tract ~-1
PERCOLATION TEST -
Depth
Feet
Soil Characteristics
Test Hole #2
6" Peat
Brown slightly sandy gravel,
occasional cobbles (GP)
17' Bottom of Test Hole
T~st ]o].e t¢ t s
l(,c~[t-~d b5 tr¢ ject
Ei[g:.n-~e]'.
Was Ground Water Encountered
If YES, What depth?
No
Reading Date I Gross Time Net ~TLme I Depth to H~q~ Ne~4 D~al~).
Percolation Rate Minute
Proposed Installation: SEEPAGE PIT DRAIN FIELD
Depth of Inlet Depth to Bottom of Pit or Trench
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of ~°~'~'~
~ approved.
(~ [O.~c t Q ~ public water system located
, Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
~ _~...,,~ID conditionally approved (see attached conditions),
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract oraer no. Approved by Date
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the J-~ d/-~:; ~'/J~ LOT I? (,./,~sc O ' public
water system was corn pleted on -~ ~' /Z~ ~'- ~' ~- (date). The system is hereby
granted interim approval to operate for 90 days following the cpmp et on date.
TITLE
DATE
As-built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
f~epproval to operate. .
B'~' TITLE DATE
APPLIC'-"iT FILLS OUT UPPER HAL '"DNLY
PropeYty Owner ~-~ ~/~ ~/~7" ~g4/~~' Phone
Mailing Addres~ .~(~, /_~ 4~'~/ ~ Zip Code ?~LL~--'~)7 g~d--~--.~./%/~:~
Buyer
Address ,~/~1t/t~'' ~.~,... , Zip Code
Lending Institution ;'- .... ~,- _ .~- --~ /,~, "- ~'~%~-~-,~ ~'t "-~14~_ ~_~'~'~'~'~'~'~'~'~-~ ?-. '~ ,~ ~ I~. ,~ I, Phone
Address ~/~,~/,~/ ~~1~/~ ,~,,~/~,~ ./~/%// C~_~./~.7~/~4/[///~-J~?C°de ,-~'{~) ~-/'~*" -.~7 ~'
/'./'~' /' - ~ .... Phone
Realty Co. & Agent ~ ~/~
Address ' Zip Code
Legal Description ZT~ /g H~ S/~,
Street Location
Type of Residence
4~ Single Family
Multiple Family No. of Bedrooms ~
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available).
Public Utility
Sewer Disposal / ~ ~
Year Individual Installed:
Individual
Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
( ~PROVED BEDROOMS ~ *CONDtTIONS OF~ O~
( ) DISAPPROVED ENVIg, .,~4r,,:, ,~
( ) CONDITIONAL APPROVAL*
AUG3
RECEIVED
Soil8 Rating ~ O~te ~wer Installed Well To Ab~orplio. Are~ Well Log Reo~ived
/50 ~ 7--/~~ Well to Tank Septic T~k Size