HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 23o' 4 14
GR'""TER ANCHORAGE AREA BOROU~
, HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99S01 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ./_: ,
ADDRESS~ ~.~-~T4/~ ~ ~.~'. PHONE
LEGAL DESCRIPTION ~-~'~ ~'~/-~' ~..
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELl ~' ~ MATERIAL ~~ COMPARTMENTS,
LIQUID CAPACITY /~ ~ ~ GALLONS. INSIDE LENGTH '~ ~
INSIDE WIDTH
J
LIQUID
_DEPTH
SEEPAGE SYSTEM:
SEEPAGE PIT:
LINING MAIERIAL f ' I ,DISTANCF~ELI
NEAREST ~,~LINE {i ~SORPTION AREA ~ALL AREA)
TILE DRAIN FIELD:,~j;~~-~
DISTANCE FROM WEL , FOUNDATION /"~'~ "~ , NEARESI LOI LINE
NUMBER OF LINES ~
^BSO PT ON AREA
DERIH: lOP OF TIlE 10 FINISH GRADE
LENGTH , DEPTH
SO. FI.
TRENCH WIDTH
TOTAL LENGTH
. OF UNES /~"-.'~
IN. TOTAL EFFECTIVE
SO. FL LENOTHOFEACHLINE/L~/~1 / ~ ~:~ /.
~ / DEPTH OF FILTER ~TERIAL BENEATH TILE ~ IN. ABOVE TILE
WELL: TYPE~ DEPTH /,~' DISTANCE FROM ~ WATER
. BUILDING FOUNDATION, ~ SAMPLE ~4./~;, NEAREST
~/NEAREST / SEPTIC /- ~ ~
LOT LINE ~ ., SEWER LINE TANK ~. SEEPAGE ' OTHER
SYSTEM ~ . CESSPOOL . SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE ~~"'~
,. /
GAAB-HD-2
GREATE~/"ANCHORAGE AREA r'%JROUC, H
Case No.~-~-
,; I lEA LTH DEPARTMENT
327 Eagle'St. Anchorage, Alaska 99501 279-2511
/SEWAGE DISPOSAL SYSTEM... - APPLICATION & PERMIT
RES,OENCE ADORESS
LEGAL!ES~,'PT'ON ~ T v-~ ~-~ 'Z (~.?4,m ~;, "'-/·
APPLICATION TO INSTALL: SEI~'[IC TANK. 1//' SEEPAGE PIT . DRAIN FIELD OTHER
TO SERVE THE FOLLOWING FACILITY/
FINANCED THROUGH
PERCO~T~ON TEST RESULTS i /~0 ~I/,"~vP-rdr, NT~C~PATED DATE OF COMPLETION ~ 4, ~y' t,'~n~"
/
!BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
AS DI~SCRIBED
· SEPTIC TANK SIZE
SIZE OF UNIT TO BE SERVED ~"~-~ {~ {~ {~
;PAGE ::Z)/?a//L)
~.-~-~-~¥"~"DIAGRAM OF SYSTEM !,~/...-,~Z~
DISTANCES: D 0 T
O0 "n-I{~ Lo-r' /~' ~
' 8
I certify that I am familiar with the requiremen!s of Greater Anchorage Area Boroug~_h~Oyrdinance No. 28-6 and that the
above described system is in a~cordance with sa~d code. /5~'. ~, F-->'' .,
.. /I ~.~