HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 20fl
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Gpr~.TER ANCHORAGE AREA BOROUGH
~ ' HEALTH DEPARTMENT f ~
327 EAGLE ST. ANCHORAGE. ALASKA 99501 279.251
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS. __PHONE
LOCATION : LEGAL DESCRIPTION~e'T 2~ ,~ 7 ~, ~
SEPTIC TANK:
DISTANCE FROM WELL ~ MATERIAL ~=~ NUMBER OF
COMPARTMENTS,
LIQUID CAPACITY .GALLONS. INSIDE LENGTH INSIDE WIDTH ~OEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
.LINING MATE tlJ4~.~_...~.,,'"' ' '~'--~?'A'NCE FROM WELl (,,......_/ ~ ~ING FOUNDATION
NEAREST LOT LINE ~ . TOTAL EFFECTI'VE ABSORPTION AREA (WALL AREA) SQ. Fl,
TILE DRAIN FIELD:
ABSORPTION AREA
DEPIH: TOP OF TILE TO FINISH GRADE
FOUNDATION ,, NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE ~"~'' ~ ~'"'''~ ~* /~'
TOTAL LENGTH
, OF LINES ''~'"'"l,~' ,
IN. TOTAL EFFECTIVE
.DEPTH OF FILTER MATERIAL BENEATH TILE .,~L]~ IN. ABOVE TILF /Z"
DISTANCE FROM WATER
WELL: TYPE DEPTH . BUILDING FOUNDATION, SAMPLE . NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE .. SEWER LINE, , TANK . SYSTEM , CESSPOOL . SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE '
OAAB-HD-2
}
GREATEr 'ANCHORAGE AREA/~OROUGH
{ IIEALTI! DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAdE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME DF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
MAILING ADDRESS PHONE NO.
LOCATION OF INSTALLATION ~f~ ~ ? ~/'J~ff/~
APPLICATION TO INSTALL: SEPTIC TANK '~ , SEEPAGE PIT Y , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING F~CILITY / ~/
PERCOLATION TEST RESULTS ~/~ ~ ANTICIPATED DATE OF COMPLETION --
{BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~' , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED.
· SEPTIC TANK SIZE
DISTANCES:
TYPE ~r)t,~ SEEPAGE AREA t~/ff~ TYPE
"'~/' mAGRAM OF SVSTm
ify that 1 am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above des~qbed system is in a~:cordance with said code.
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