HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 19
; GI~TER ANCHORAGE AREA BOROI~'~H
HEALTH DEPARTMENT
!327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION~REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
o~s~,~cE FRO~ WE,LL:
LIQUID CAPACITY ~ GALLONS.
SEEPAGE SYSTEM: SEEPAGE
NU, BER OF PIT,<t ! LENGTH
NEAREST LOT LINE ~- TOTAL EFFECTIVE.~,.~_ORPTION AREA (WALL AREA)
DISTANCE FROM W I//~,/' . _ -~/'~, FOUNDATION'~/'),--,-~_ /"~ . NEAREST LOT LINE
NUMBER OF LIN~S ' DISTANCE BETWEEN LINES
.SQ. FT.
TOTAL LENGTH /,,,~//
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA ~'Lr~
DEPTH: TOP OF TILE T,~, FINISH GRADE
SO. FT. LENGTH OF EACH LINE ~'~'~ ~
DEPTH OF FILTER MATERIAL BENEATH TILE ~ IN. ABOVE TILE ~/~ ~''
I./ DISTANCE FROM WATER ~,/'
. DEPTH , BUILDING FOUNDATION. ~ SAMPLE /&~ .o NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ~ . SEWER LINE t,/ , TANK ~ , SYSTEM e,,-'"' , CESSPOOL v o SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE
GREATEI~&NCHORAGE AREA C'DROUGH
° I llEALTI! DEPARTMENT
327 Eagle St. Anchorage, Alaaka 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF ~.c~%' ~ ~
RESIDENCE ADDRESS ~
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SE~IC TANK
JBELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
Case No. ~'7'~'/
/,,-"~, SEEPAGE PIT
!
MAILING ADDRESS ~7,~) f~'~/~E/~/ '~/~:~NE NO.~
. ~OCA~m. o~ ~.s~A~o.~//~/~ff ~
, DRAIN FIELD ~ ,OTHER
TO RE INSTALLED .V ~D~ ~::::,
THIS IS TO SERVE AS
DISTANCES:
u~faj 1~,~1~ ~ ~;,'~
/
4~)(~27T y p E ~7,~
DIAGRAM OF SYSTEM
.c....o...,o... I
! ccrt/fy that ! am famQ~r with the requ~'cments of Greater Anchorage Area Boroug~ Ordnance No. 28-68 and that t~c
above described system is in accordance with said code.
DATE
APPLICANTS SIG~IATURE