HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 28b
G]~, TEE ANCHORAGE AREA BORO)tG~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950t 279-25t!
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOC^T~ON ~ ~ :" ~
SEPTIC TANK: ~
D~SJ~.CE F.O~ W~U ~' ~ ~
LIQUID CAPACITY ~ ~ GALLONS.
MAILING _
ADDRESS ~'~ ~--- , ~ PHONE _~/~
NUMBER OF
MATERIAL ~.~ ~-----~,~ COMPARTMENTS,
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH__
SEEPAG~E SYSTEM..~
NEAREST LOT LINE
TILE DRAIN FIELD:
TOTAL EFFECTIVE ABSORPTION AREA JWALL AREA}
DISTANCE FROM WELL~-~'~n'' ~ , FOUNDATION
NUMBER OF LINES '~ i DISTANCE BETWEEN LINES
ABSORPTION AREA ,,-~,~--~ !
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FT.
NEAREST LOT LINF v/.~. / TOTAL LENGTH v//
· · OF LINES /'
~/~'~ 1RENCH WIDTH ~ IN, TOTAL EFFECIlVE
DEPTH OF FILTER ~TERIAL BENEATH TILE ~ IN, ABOVE TILE
WELL= TYPE~"~,~/,'~' ~ZZ/P ~ DEPTH ~
. _ NEAREST ~ SEPTIC
LOT LINE ., SEWER LINE. ,, TANK
DISTANCE FROM ' ~ WATER
BUILDING FOUNDATION.__SAMPLE /~'~ , NEAREST
SEEPAGE , . __ OTHER
, SYSTEM , CESSPOOL -- , SOURCES
DISTANCES:
GREATEI~ANCI. IO'I:{AGE AREA ~'OROUGH
II£ALTil DEPARTM£N']~
327 Eagl~e St. . .. Anchorage, Alaska 99501 279-2511
sEwAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~/¢.~jc/
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SE~IC TANK ~ ,SEEPAGE PIT.
.t'/,
MAILING ADDRESS 'TL~ ~)~',~P,5~ PHONE
LOCATION OF INSTAL~TION. ~ ~ g~
, DRAIN FIELD ~ ,OTHER
FINANCED THROUGH TO BE INSTALLED BY - -
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
;BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS Jl~. ~e'~ o PERMIT TO INSTALL A _,~'~'/./.A~ AS BESCRIBEB 8ELOW, SIZE OF UNIT TO RE SERVED. '~'
, SEPTIC TANK IZE ."7~;~ TYPE ~'/~--~ SEEPAGE AREA TYPE
DISTANCES:
I certify that I am familiar with the
above described system is in accordance
DATE
/ l~'~,~'
/ '7' / / /)
/ // / / .
// / / i/__~-
~/ (.-/ / -~-t
·
requirements of Greater Anchorage Area Borough Ordin, rice No. 28-68 and that the
~ce with said code. '~~ t~t~ ~ ~.
_ APPLICANTS SIGNATURE
~'~GREATER.ANC~ORAGE AREA BOROUGH/~
HEALTH DEPARTHENT
327 EAGLE STREET
ANCHORAGE, ALASKA'99501
LeKal Description; Lot ~ Block
Thxs Form Re~orts/a. Sozls Log
Depth | '
Feet Soil Chara:teris~Ics
7hd Sed,'.~enk
Date Performed 39 ~,,, Iq'tO
,$ubc,visicn ,t,'r,m.~l, ol~ ~.te~e;lljl'~
· .~ercol~tion I~s~
Was G~ound Water Encountered?
t
If Yes, A W Depth ~'-'~"
Reading Date Gross Time Net Time Depth To H20 Net Drop
{
{
{
Fro~osed Instal~Seepage Pit Drain Field
Depth Of Inlet
COMMENTS:.. ~,
Test Perforv~d ~I'
Data Certified By~'~,
! DATE RECEIVED
INSPECTION APPOIN~'MENTS
TIME ,'i rIME TIME~}[
DATE ; DATE DATE
,NSPECTOR I ,NSPECTOR ,.SPEC.OR
MUNICIPALITY OF ANCHORAGE MUNIOPNJTY OF ANO'IO;~,G[
DEPARTMENT OF HEALTH & ENVlRONMENTAl PROTECTION DEFT. OF
) i 825 L Street - Anchorage, Alaska 99501
I ENVIRONMENTAU ~ .,.??:CTION
ENVIRONMENTALSANITATION DIVISION OEO 3 0
Telephone 2644720
;
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER'~ ~-'~6~[r~L)
DIRECTIONS: Complete all peris on page 1. In¢omplet® requ~t~ will not be proce~. Please allow ten (10) days for processing.
t. PROPERTY OWNER ; ~ PHONE
~V~e].ody Sales Thc.I 279-3528
MAILING ADDRESS
3115 Hountian View Dr.,' Anchorage, Alaska 99501
PROPERTY RESIDENT (if different from abo~el PHONE
2. SUYER I PHONE
Chester Haley 333-8488
MAILING ADDRESS
3457 E. 65th 'Avenue, Anchorage, Alaska 99502
3. LENDING INSTITUTION , [ PHONE
Peoples Bank :and Trust Company] 279-7511
MAILING ADDRESS
Pouch 7007,I Anchorage, Alaska 99510 : ATTN: Karen Johnson
4. REALTOR/AGENTN/A }[[ PHONE
MAILING ADDRESS
B. LEGAL DESCRIPTION j
Lot 28~ Block 8 Campbell Heights S/D I1
STREET LOCATION ] Anchorage~ Alaska 99502
3547 E. 65th Avenue1
6. TYPE OF RESIDENCE i NUMBER OF~BEOROOMS
r--I One F"I Four
I~ SINGLE FAMILY Hobtle Home
, [] Two [] Five
[] MUI'TIPLE I~AMILY ~ Three [] Six
[] Other
7. WATER SUPPLY i [] INDIVIDUAL'
COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
I~'~. YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY '
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[] PUBLIC UTI LITY
Connection Verified
I-'lSepticTank or []Hold[ngTank
Size: If Tank is homemad~
live dimensions:
NUMBER OF BEDROOMS
I--I ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Septic/Holding Tank
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] OTHER
jNearest Lot Line
5. COMMENTS
DATE
[~"~APPROVED FOR ~' BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)