HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 30
HEALTH DEPARTMENT
-~ 1327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
-'~ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~-~.~'~.,~'~'~' ,,,,~'~'-,~"~
SEPTIC TANK:
DISTANCE FROM WELL..~"~'~'~t~-~-~,'~---~.~MATERIA[ ~-~-,~L~'~"~'~----COMPARTMENTsNUMBER OF
LIQUID CAPACITY ~ GALLONS. INSIDE LENGTH INSIDE WIDTH. DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ~ OUTSIDE DIAMETE. I~'~ ~) OR WIDTH
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPlION AREA (WALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL ~/)"~'~'~'~"~ ~ , FOUNDATION
4/ '
NUMBER OF LINES · : DISTANCE BETWEEN LINES
ABSORPTION AREA .2~',~ ~
DEPTH: TOP OF TILE TO FINISH GRADE
,SQ. FT.
~° . NEAREST LOT LINE /~'q ~ oFTOTALLINEsLENGTH~"~'~ .'~ ~.//
~CH W,D,. ,.. ,o~ ~.~c~,v~
~ / DEPIH OF FILTER MATERIAL BENEATH TILE ~ IN. ABOVE TILE ~
DISTANCE FROM ' , ' WATER
WELL: TYPE ~'~,~'~/)/._./'x/-~,~,). DEPTH , BUILDING FOUNDATION.__S~PLE ~ , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ' . SEWER LINE .. TANK , SYSTEM , CESSPOOL , SOURCES
D,~o,~ o~ ~s~
~,s~CES: y '" ........... : ....... I ......
.... : ........ , j T,, ' ~ I ' '1~
GREATEI ANCHORAGE AREA ' OROUGH
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~ HEALTH DEPARTMENT
327 Eagle St. Anchorage, A~ska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICAN'~'~ ~"'t~g~'~"~ .AILI"G ADDRESS ~g~
RESIDENCE ADDRESS LOCATION OF INSTAL~TION ~'
LEGAL DESCRIPTION ~ ~ ~ 7
APPLICATION TO INSTALL: SE~IC TANK ~ ,SEEPAGE PiT ,DRAIN FIE~O ~ , OTHER
TO SERVETHE FOLLOWING FACILITY '~g~ ~ c ~ [~.
PEflC0~TION TEST RESULTS ~'" '~ ~ ~' ~TIClPATED DATE 0F C0~PLETq0N
BELOW 0 BE FILLED OUT BY HEALTH DEPARTMENT
/, _ / ,.,/~
AS DESCRIBED BELOW SIZE OF UNIT TO BE SERVED ,e-~// i~t,I,~i · .'
~j~ ~ ~?~ DIAGRAM OF SYSTEM
.DISTANCES:
X certify that ] am familCqr with the requirements or Greater Anchorage Area Boroug~ O~tbl'~'~'qe No. 28-68 and th.t the
above des~ibed system is in accordance with ~id code. // '"'/~ ] ~