HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 6
GAAB.HD.I
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251!
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ~~
ADDRESS_
LEGAL DESCRIPIION.~-~'
MATER~^L ~t~ PC-~n~b':
GALLONS.
PHONE
NUMBER OF /
COMPARTMENTS
i %w ,~ LIQUID
INSIDE LENGTH. ~- .INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PIS
LINING M ATE RIA~ ~.~
OUTSIDE DIAMETER OR WIDTH
~WELI ~
LENGTH , DEPTH
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA(WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
· WELCh! 4~2 t ' TOTAL LENGTH,, ~:~' ~
DISTANCE FROM ,~'~ ~ , FOUNDATION ~/~'~' ~ . NEAREST LOT LINE ~ . OF LINES /rU
'
~ ~.ENC. W,D~. · ,.. ,o~ E~EC~,V~
DEPTH OF FILTE, MATERIAL BENEATH ilL/ IN. ABOVE DLE
WELL: TYP~~ ~ ~ DEPTH ,,UlLDING FOUNDAIION ~ S~PLE ~e , NEA,EST
DISTANCE FROM · WATER
NEAREST / SEPIIC SEEPAGE // OTHER
LOT LINE ~.,,/c.-.- , SEWER LINE ~ TANK /., SYSTEM , CESSPOOl /, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GAABqlD-2
GRE,~TE~" ANCHORAGE AREA r'5~OROUGH
i HEALTil DEPARTMENT [ ~/
327 Eagle St. Anchorage, Ahs~. 99501 279~- 5~~
SEWAGE DISPOSAL SYSTEM APPLICATION & PERMIT
NAME OF APPLICANT,~'~'~/ ,~.c~.~ MAILINB ADDRESS q~q ~ ~r ~ ~[/ PHONE NO.
RESIDENCE ADDRESS ~ LOCATION OF INSTAL~TION ~ /~
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS ;
· OTHER
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
T,,S ,S TO SE,VE AS ./4 .PERMITTO,NSTALLA./,
SE.lC TA.K SlZE~7¢ TY,E SEEPAGE AREA/[¢~¢f TYPE ~
~ ~ ~, DIAGRAM OF SYSTEM/
DISTANCES: ,
~,o_ '
I certify that I am familiar with, the requirements of Greater Anchorage Area Borough Ordinan~;~No. 28-68 and that the
above described system is in accordance with said code. ./~ /" ) .
DATE , /'¢~ ' APPLICANTS SIGNATURE