HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 8
/ G~,ATER ANCHORAGE AREA BORO~t~G,H
HEALTH DEPARTMENT
~-"' ° !327 E~GLE ST. ANCHORAGE, ALASKA 99501 279-251 !
· INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON ¢C'_.
SEPTIC TANK:
DISTANCE FROM WELCL"P~-~-~- ~) MATERIAL
LIQUID CAPACITY /?, ~"O ! GALLONS.
,,.:,_ ,.,.~_._,~__. NUMBER OF
COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDT' DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
, O~.__..~ F R~UILDING FOUNDATION
NEAREST LOT LINE ~ . TOTAL EFFECTIVE ABSORPTION AREA {WALL AREA) SQ. FT.
DISTANCE FROM WELL ~----------~' ,~/--~ ~1. FOUNDATION ' / TOTAL LENGTH-'
., NEAREST LOT LINE ,, ~ , OF LINES //(~
,,SOR,~O~*~* /~/~ s~.n. ~m~.O~,*C. UN~]~/- /~' /
DEPTH: TOP OF TILE 10 FINISH GRADE ~ DEPTH OF FILTER MATERIAL BENEATH IILE IN. ABOVE TILE ~
~/ DISTANCE FROM WATER
WELL: I~'PE~"~/~ /~/-,~ -- DEPTH ~ . BUILDING FOUNDATION S~PLE ~ NEAREST
NEAR~ST SEPTIC SEEPAGE OTHER
LOT LINE ~ .. SEWER LINE lANK ~ . SYST~ ~ ~ CESSPOOl . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
o,,,,..,.o., GREA~E.r'",~ANCH ORAG E AREAr~OROUGH
· i IIEALTil DEPARTMENT
· 327 Eagl~ St. Anchorage, Ala~,a 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION ~.~
APPLICAIION TO INSTALL: SE~'IC TANK
.,.ANCEDT.ROUG. TO BE,NSTALLEO BY
PERCOLATION TEST RESULTS ! ANTICIPATED DATE OF COMPLETION
BELOW TO liE FILLED OUT BY HEALTH DEPARTMENT
LOCATION OF INSTALLATION,
· SEEPAGE PIT ,X" , DRAIN FIELD
/,,,,,,~.~
MAILING ADDRESS ~'J/7,~,ff~/~,,~5 PHONE
//~
,OTHER
THIS IS TO SERVE AS '~'~'"~'] ~ ,PERMITTOINSTALLA. AS D~SCRIBED BELOW. SIZE O,,.F U~NIT~T,O BE SERVED
. SEPTIC TANK SIZE ~ TYPE ~ SEEPAGE AREA
~ DIAGRAM
DISTANCES:
28-
I certify that I am familiar wit,h the requirements of Greatei ~nch°rage Area Borough Ordinance No. 28-68 and that the
above described system is in ac. cordance with said code. t,,'d~/~, ' ~d.~,~ ,&,'x.,~ ~