HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 7 LT 33o'14 o'b
GRERTER ANCHORAGE AREA BOROUGH
~ ~ HEALTH DEPARTMENT t ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS ~-///C ~"~.~",~.-..~. /~t~"'PHONE
LOCATION ~'/~'~//~--~'~'- /~"' LEGAL DESCRIPTION ~(~7" '~."~ '~ ~'~, /~"' 7.
SEPTIC TANK: ~---~/f~- ~--
DISTANCE FROM WELl
GALLONS.
INSIDE LENGTH
NUMBER OF /
COMPARTMF~NTS
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER ~ OR WIDTH
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~(~'~ ,FOUNDATION //~ NEAREST LOT LINF /'~ ' TOTAL L EN GTH """J' "') V
. . OF LINES
IN. TOTAL EFFECTIVE
,,SORPTIONAREA ~ ~Q.F,. LENGTHOF EACHUNE /~X~~
WELL: lyp_E~,,~/~Z~.~.-l~ DEPTH ~
NEAREST . .~- SEPTIC
LOT LINE '~' . SEWER LINE ' , TANK
DISTANCES: - - - j
DISTANCE FROM
BUILDING FOUNDATION
! SEEPAGE
"~C ~ , SYSTEM
WATER 4',~
SAMPLE l(,/~" , NEAREST
DIAGRAM OF SYSTEM
DATE ~/~/~/f~ APPROVED
GREATEF'"~NCHORAGE AREA f~ROUGH
IIEALTit DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
c=~e No. ¥~/
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT MAILING ADDRESSY;'~ ~)-'<f" ~ ,.~/ PHONE NO.
RmOENCE,',OGRESS LOCATION OF INSTAL~T~ON
APPLICATIOH TO IHSTALL: SE~ICTAHK ~ , ,SEEPAGE PIT__,DRA~ FIELD~,OTHER
FIHAHCED THROUGH TO BE mSTALLED BY,~Z/
PERCO~TIOH TEST RESULTS AHTICIPATED DATE OF COMPCETIOH
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
DISTANCES:
7~4 ~' .PER.IT TO
,,so,.s,,,,,,,,,,,:,.o,,,,.
,, . '
· SE"lC TANK SIZE.J:~~'"-' TYPE(- ~ SEEP^GE\AREA
~.~ ~ mAGRAM OF SYSTEM
I certify that [ am familiar with the requirements of Greater Anchorage Area Borough Ord~SS and that the
above described system is in accordance with said code, ~~~~.r~~
DA',',':,,', APP',CANTSS.'..ATDRE ·
GP~.ATER ANCHORAGE ARBA BORI3UGH
Department of Envtroraaental Quality
Tudor Road, Anchorage, Alaska gg507 279-8585
Date
Time of Inspection , '--~"- _--_.
Date of Inspection
REQtJEST FOR APPROVAL OF
II~1~/IERLRL .~IER & WATER FACILITIES
FOR
3. Legal Descrtpt ·
4. Location: ,-~'- ' , ~: ~2~'~'
5. T~e o~ Facility to be Inspected: //~L~- .~'-~ ~.~.4[. ~
Depth ~-~-
Bacterial Analysis
SewaGe Di,~,oeal .System=
A. ~nstelled~
D. Seepage Pits 1. Size~~ 2. ~tedal: -~--~: ~/~
~. Disposal Fteld: Total ~th
A. Well
C.
Septic Tank__.~_~..,~, Absorption Area ~¥.~o · Sewer Lines
, Nearest Lot Llne.~.~,~_, Other Contamination
F~,undetton to Septic Tank "~ AbSorption Ares
A~oretion A~ee to Nearest Lot Line /0 - ~ ....
Page Two ~,~]
royal laird for One Year From Date
G~ate~ Anchorage Area BoTough, Da;at~cment of Envt~o~enta]
DTAGRAMOF SYST~
ce?t! fY ~,ha% ~.he tnfo~mation contained ~-n th18 ~equaat lot appc=ve! to be a tt-ue
· nd accurate ~epresen~et~.on of Lhe euh.~ect ~ewe~ and wete~ fac$~4-t~ee located at:
Stqnad Date