HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 9
HEALTH DEPARTMENT
:327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCA,,ON ~-:.'~.' - ~-~---./ ~,-'-.~--. lEGAL DESC,,PT,ON X-:~' 3- ~'~"~ ~"~'~-"~'
SEPTIC TANK: t "~'~"
NUMB"OF /
DISTANCE FROM WE - MAIERIAL ~'~- ~_~--~7"~ COMPARTMENTS
~ ~ ~ ~ ~?~ uou,o
LIQUID CAPACITY. , ~ ~AllO~S. I~DE lEnGtH ' I~SIDE WIDTH. ~ DEPTH
SEEPAG~E SYSTEM:__ ~T:'~ ~'
NUMBER OF PITS / 'OUTSIDE DIAMETER O~ ,LENGTH ~
NEAREST LOT LINE ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAl ' ,SQ. FT.
NUMBER OF LINES ~ I DISTANCE BETWEEN LINES ,~ /
DEPTH: TOP OF llLE ~O FINISH ORAD~/~ ~ OEPTH OF FILTER MAlaRIAL BENEATH TILE
, TOTAL LENGTH//,~ /
. NEAREST LOT LINE ~ , OF LINES /, ~ .
TRENCH WIDJH ~ IN. /OTAL EFFECTIVE
IN. ABOVE TIlE
DISTANCE FROM / WATER
WELL: TYPE /~-~,~/'~-. '~'~'"~[~/. DEPTH / ,BUILDING FOUNDATION.__SAMPLE ~ , NEAREST
NEAREST / SEPTIC ~ SEEPAGE ~ , CESSPOOL , SOURCES
[O! LINE ~ .. SEWER LINE .. lANK , SYSTEM ~ OTHER ~
DISTANCES:
'~'~,~ ~ -.~ ~ /??,'~ APPROVED
DATE ~ ~. -.~ ' .e^[I. ~,u~.OmtV
OAAB-HD-2
GREATEI ANCHORAGE AREA f'"OROUGH
I IIEALTil DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
c,. No. 5c'6
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIOENCE AOORESS ~.y,"v',.,.~. LOCATION OF INSTALLATION C"~,V~-/,~/ ~
LEGALI:JESCRIPTION ~ g] ~ 7 ~,~/ /~ ~
APPLICATIOH TO INSTALL: SE~IC TANK ~ . SEEPAGE PIT Y . DRAIN FIELD . OTHER
FINANCED
PERCO~TION TEST RESULTS--~ ~ ANTICIPATED DATE OF COMPLETION
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
DISTANCES: '
'~'~"'~". ~ .PERMITTO INSTALLA
AS DESCRIBED BELOW. SIZE ~0 BE SERVED
I "7S'~) .TYPE ~ .47':~] SEEPAGE AREA
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
w,th said code. ~ .~ _ / ..~/~2.'.-Y/ ~' .,.~. ~.. ,--'
above described system is in ad, cordance, ' . ' '-' /lc.// d.~..?~/C4//.,,,O.~..~.~.~z,.~,[- ' ~.j~,~/* ~
DATE APP~I~TS Si6,ATURE _ ~,~ ~/,', .-