HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 7~k~ ~,
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~ G~P-~,,~TER ANCHORAGE AREA BORO~t~H
! HEALTH DEPARTMENT
· -~ 327 EAGLE ST. ANCHORAGE. ALASKA 99501 279-2511
· INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCRIPTION
;
SEPTIC TANK:
L. NUMBER OF ./
DISTANCE FROM WELL ~-"~'-"~ ~ ~-~ MATERIAl. ~" (~ ~'~ COMPARIMENIS
LIQUID CAPACITY ' GALLONS. INSIDE LENGTH INSIDE WIDtH__DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
LINI~d~'MATERIAI i ~ DISIANCE FROM WELL ., BUILDING FOUNDATION__
NEARESt LOT LINE ' . tOtAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. Ft.
TILE DRAIN FIELD: ~
DISTANCE FROM WEL[J~ ~/~---~ ~, FOUNDATION ~ /. NEARESt LOT LINE / ~:~ / oFTOTALLINEsLENGT" j/~
NUMBER OF LINES ~ t DIStANCE BETWEEN UNES~! ~' /~ / tRENCH WIDTH' '~ /
ABSORPTION AREA j
DEPTH: TOP OF tile tO FINISH GRADE
SQ. FT. lENGTH OF EACH LINE j ~'~ "~'~
.,~..I,/~.. / DEPTH OF FILTER MATERIAL BENEATH TILE
IN. tOtAL EFFECTIVE
/~ /c> "
IN. ABOVE TILE
~ ; DISTANCE FROM WATER
WELL: TYPE ~/~' ~'). DEPTH ~ oBUILDING FOUNDATION. SAMPLE , NEARESt
NEARI~ST SEPTIC SEEPAGE OTHER
LOT LINE . SEWER LINE ~., TANK ~ , SYSTEM -- , CESSPOOL ~ , SOURCES~
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATE?'ANCHORAGE AREA ~OROUGH
IIEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
L
NAME OF APPLICANT //~.~'L'
//
/
RESIDENCE ADDRESS !{o/
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
MAILING ADDRESS
LOCATION OF INSTALLATION
SEEPAGE PIT ~ , DRAIN FIELD
Case No. ~'~/
PHONE NO.~
,OTHER
TO SERVE THE FOLLOWING FACILITy
FINANCED THROUGH .~l.e ..~f
PERCOLATION TEST RESULTS I ~5)/(:'t'~ l'J '~0~ ANTI CIPATED DATE 0 F CO M P LETI 0 N
BELOW TO BE FILLED GUT BY HEALTH DEPARTMENT
T.,S ,S TO SERVE AS i oo,% .FER,,,TTO,NSTALLA
As OESCmBEO ,ELOW. S,ZE O~ Um~ ~0 ~ SEnWO
' /~ TYPE ~r~EEPAQE AREA
. SE~IC TANK SIZE
DISTANCES:
~' x~' .- ,,
HIEAI AUTHORITY
~'(") .ZT' TYPE
L~ 4~.~-''- DIAGRAM OF SYSTEM
I certify that I am familiar wit,h the requirements of Greater Anchorage Area Borough, Ordinance ~o.~-68 and that the
above des~ibed syste~ is in a~cordance with ~id code - :~ '