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. ~ / /