HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 8B
Department of Environmental Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~o~..o. ~. ~ 7~x ~ ~?~ ~.~o~.,pT,o. Z .t~ ~tt~
S~ ~ANK:
DISTANCE R~~ ~O/4j(,¢/(~4.~__~..' NUMBER OF
FROM WELL ~'~) /' MANUFACTURE 'A)'Z~"'~" MATERIAL COMPARTMENTS O~
INSIDE LENGTH INSIDE WIDTH LIQUIDDEPTH IIQUID CAPACITY GALLONS.
SEEPAGE PIT:
NUMBER O F PITS ~/,~T ER _ ~"'~ID~,,~ LENGTH--. DEPTH
LINING MATERIAl.,,/ _ CRIB SIZE; DIAMETER '"',.DEPTH DISTANCE FROM: WELL
~ ~AL EFFECTIVE
ADDITIONAL ABSORPTION '
SQ. FT.
WELL.'
TYPE
BUILDING
FOUNDATION
CESSPOOL
~ CTION DEPTH '~ DISTANCE FROM:
NEAREST NRA R EST~'"..~ SEPTIC SEEPAGE
LOTLINE SEWER UNE~..~ , TANK.. ~VSTEM~ .
OTHER SOURCES .
REMARKS
APPROVED
DISAPPROVED
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE: ~'~'~ ~ .
REMARKS:
Form PW-026
DIAGRAM OF SYSTEM
DATE
I'ER ANCHORAGE AREA BOROUGH
WAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
I.STALLAT,ON LOCATiO. ~ ~'~C
LEGAL D.ORI.,O. /6r
/-~',/Z~,,~'
TYPE AND BIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
PNO.E
SEEPAGE PIT DRAIN FIELD
TO BE INSTALLED BY
OTHER
BOIL TEST RESULTS
COMPLETION CATE ANTICIPATED
/
NOT~; THIS PERMIT IS NOT VALID WITHOUT SOIL I'~ST
FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL. SE SUBJECT TO PROSECUTION.
TYPE, SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO ~EPT4~-TANK
CRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
TO RIVER, LAKE, STREAM.
SEEPAGE PIT
DRAIN FIELD
CAST IRON INTO AND OUT OF EEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
CONFORM TO E~OROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28°68 AND THAT THE ABOVE
