HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 25
GRr. ATER ANCHORAGE AREA BORO~,LGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950! 279.251!
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
SEPTIC TANK:
. DISTANCEFROMWEL~Jf'~'.F/i,/'3~,~ MAI'ERIAL
LIQUID CAPACITY
~,f~. tl~ .~-,' o ADDRESS PHONE
NUMBER OF
,~-~' 7 ~.) L,OU,D
GALLONS. INSIDE LENGTH. .INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITT' i OUTSIDE DIAMET~"'-~ OR WIDTH
LINING MATERIAL~'~''~''~~'~ ,DISTANCE FR~
· BUILDING FOUNDATION
NEAREST LOT LINE.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WEL~'J~" ~'~) .FOUNDATION
NUMBER OF LINES ~ ' DISTANCE BETWEEN LINES
ABSORP;,ON AREA /~ ~'7~
DEPTH: TOP OF TILE TO FINISH GRADE
,
/~ ,/ NEAREST LOT LINE /~ / TOTAL LENGTH //
, OF LINES /
SQ. FT. LENGTH OF EACH L,NE / ~ )~ r ·
~ DEPTH OF FILTER ~TERIAL BENEATH IILE IN. ABOVE TILE
WATER
SAMPLE
WELl.:
DISTANCE FROM
TYPE '%~"~ '~. DEPTH ~ oBUILDING FOUNDATION. /1/,j, . NEAREST
NEARESI SEPTIC SEEPAGE ~ OTHER
LOT LINE ~ . SEWER LINE ~ ,JANK ~ , SYSTEM ~ , CESSPOOL , SOURCES
DIAGRAM OF SYSi~
DISTANCES:
· .:... :::::;'l~*~./...~,.,l: .... :.:.j..~.=j ....
..... Il I',¥ -~. ~,,: .~ ~ . : . : . ..............
:.-:- ...... :
...... ~ . :~ ...~,-. ~ f~ :~::;.-~ ....
' ' ' i : ..... "' ' ' : ' ; ' ;
~;' ~ :-. u.,,, :~:':'::J::..~.::~[: ....
-.-,,- .~, : '.'..-~ . .' ..... -y ... ~: .':. :: :~ .': .:
............... T ....................... ~ ......... [ ....... ~
~-:.::':~ ~ ....
DATE
GREA'~EI~ANCHORAGE AREA ,f'=~)R H
327 Eagl~e St. Anchorage, Alask~ 09501
NAME OF APPLICANT/Z~f~''~
RESIDENCE ADDRES~
LEGAL
~ ~,~'f MA~UNG ^DDRESSq2~ 2) ¢,r ,~', .~// PHONE
DESCRIPTION~ ~/F ~" ~ 2~
APPLICATION TO INSTALL: SE~IC TANK , SEEPAGE PIT , DRAIN FIELD ~ , OTHER
/
PERCO~TION TEST RESULTS ANTICIPATED DATE OF COMPLETION
~BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
DISTANCES:
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ "L~'/'Z44'~'
TYPE SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in a~cordance with said code.