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HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 5 GAAB. HD-I G~TER ANCHORAGE AREA BORG/II,," HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251! INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /'"~J.,~J~,'~?~,~ ~.,~/ ~(",,~7--_. LOCATION SEPTIC TANK: MAILING · ..~ ~.~ ...._---- ADDRESS,~'? ~ _~.~,,_ ~Z~// PHONE LEGAL D E S C RIP TIO N ,,~f..~.~ .~'~ DISTANCE FROM WEU ~-----'~/~?'.~ ~ MATERIAL ~.O(~'~'-~,~'~ NUMBER OF COMPARTMENTS LIQUID CAPACITY ~ GALLONS. INSIDE LENGTH INSIDE WIDTH ~DEPIH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS ~IAMETER ~,..-.---~'9~'TI~H. o LENGTH , DEPTH NEAREST LOT LINE TOTAL EFFECTIVE ABSORPIION AREA (WALL AREAI SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELl ~'~'Z?~-/-~ ~ , FOUNDATION NUMBER OF LINES -~ .DISTANCE BETWEEN LINES ~>/ ABSORPTION AREA ,~"~::~ SQ. FT. LENGTH OF EACH LINE NEAREST LOT LINE TRENCH WIDTH · TOTAL I. ENGTH~//,.~ , OF LINES IN, TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE ~'~/t~. ~ ~ DEPTH ~ DISTANCE FROM ' WATER o BUILDING FOUNDATION. _SAMPLE ~ NEAREST - SEPTIC SEEPAGE LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL DIAGRAM OF SYSTEM DISTANCES: , NEAREST OTHER ~ , SOURCES DATE APPROVED °~""'"-~ GREATEr"~ANCHORAGE AREA f",OROUGH c~. No. V ~'~_ ! " IIEALTII DEPARTMENT ' 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS ' LEGAL DEscRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ' PERCOLATION TEST RESULTS ~ MAILING AODRESS.~,,2~'~ Q" X~-~ ~'// PHONE NO. LOCATION OP INSTALU~TmN ~,,,,~,,z///~ '~' ,SEEPAGE PIT , DRAIN FIELD ,X , OTHER ANTICIPATED DATE OF COMPLETION ~ELOWTO BE FILLED OUT BY HEALTH DEPARTMENT TH,S ,S TO SERVE AS /~l, F;..~ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ., SEPTIC TANK SIZE TYPE ,PERMIT TO INSTALLA. ~ /;~'~f. 7~cf. SEEPAGE AREA ~ 'T, YPE gl~t~ ]/T'~/ DIAGRAM OF SYSTEM /(',~L~t/~-~. / DISTANCES: ~Jz, ~.5~'v.:-~ - r5 · ~ ~ ~,.~,~ I certify that I am famil~r with the requ~cments of Greater Anchorage Area Borough Ord~o. 28-68 and t~t the above des~ibed system is in a~cordance with ~id code. ~ / /