HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 4
GR~:~TER ANCHORAGE AREA BORO~'t~H
r , HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE. ALASKA 99501 27~-251 !
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS. P
DISTANCE FROM WEL ,. ~,.~..,~- MATERIAL ---- COMPAJiffMENTS ,/ /'
LIQUID CAPACITY ~ ~ GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUM"EROEP"S { OUTS'DED,AMETER__ORW'DT" ' '
'~" , LENGTH , DEPIH ~ /'
LINING MATERIAL~ ..DISTANCE FROMWELI~-~'~',''f' ~"~ .'BUILDING FOUNDATION J~ ~
NEAREST LOT LINE. ~J~"'~ IOTAL EFFEC/IV[ ABSORPTION AREA ~AtL AREAl SQ. FI.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL. , FOUNDATION. ., NEAREST LOT LINE , OF LINES
ABSORPIION AREA ~ --
SQ. FT. LENGTH OF EACH lINE
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DEPTH: TOP OF /ILE.,~ FINISH GRADE
WELL: TY~ DEPTH ~ DISTANCE FROM ~ ~-,.., WATER
' ,BUILDING FOUNDATION. '"'/'""" SAMPLE /~ , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ~t/~' SEWER LINE OK , TANK ~q~'~, SYSTEM O/~ , CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES: ................ ' ..
· ..I
.............. IC'k',5%5.' ~ : . ' '
DATE
APPROVED
GREATEF-'ANCHORAGE AREA mOROUGH
IIEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. ~z~--~'''''
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
MAILING ADDRESS- % 7(0 (",.~, 15~. A'~PHONE£;::'44'{';)'5:~NO.
~EEPAGE PIT t~ , DRAIN FIELD , OTHER
FINANCED THROUGH ~')¢",{ '~ TO BE INSTALLED BY
PERCOLATION TEST RESULTS/)--~ ~ ~ t/~D/:::A'[ ANTICIPATED DATE OF COMPLETION
I
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS I$ TO SERVE AS ~"'~ ~'- "{ C) p-C.~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF~UNIT TO BE SERVED
· SEPTIC TANK SIZE~-///~)(C('~TYPE ~/f ~)tX }1 SEEPAGE AREA
DISTANCES:
! /
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 accordance with said code.
~G~d:ATER M~CHORAGE AREA BORoUGH;~
HEALTH DEPARTHENT
3;7 EAGLE STREET
ANCHORAGE, ALASKA 99501
Thxs rcrm Reports a. ~o~ls uog ~-- .... Perco{ation Test,,.
Depth
Feet
So[[ Character[st[cs
Was Ground Water Encountered?
If Yes, At What Depth'
Reading Date Gross Time Net T/me
Location Sketch
Depth To H20
Net Drop
Proposed Znstal~Seepage Pit ~ Drain Field
Depth Of lnlet ~, Depth To Bottom Of
COMMENTS: --
Test Performed
Data Certifte~
REQUESt FOR A~PROVAI, OF
ZNDIVIDU&L SZWAG~. AND WATER FACII, ITIE$
(Fill out in Triplicate)
.. t~un~.~bec~,~ms in house ~'~
b.
b. ~aptk, ,
c. Casin~ Size ,,
Distance f~om well to closee~ existini o~ p~oposed:
2. Septic tank ,, .
3. Seepage
~. Cessp~
5. P~pe~y Line
Sewage disposal system,
a, AEe of system
b.
1. If "home made" sho~ dia~ra~ on reverse side of ~his fo~.
dj Disposal ~leld or seepage pit size a~d type ~-~ -~e~
a '2-4/ Zl /
1. ~lst~ce ~o p~~e~¢~ to ho~se ~o~i~ /~ ,t
~%~A f. Percolation Test performed by, , .
~ ~Use the reverse .side of thls form to show .die, rem. Dia~rsn~ should include
..~_he followln~ lnf.ormatlon: pFoper~y lines,.well location, house location,
~v~-c tank location, disposal area location, location of percolalion test,
~ direction of ground elope.
9. The ~tion on this form Is true and correct ~o the best of mM knowledge.
\ Signature of Applicant l~a'Te Sl~ned
~0 BE FILL. ED OUT BY HEALTH DEPAP, T~'.'~ENT PEI~SON_~r.
~e above described sanitary facilities are hereby approved, ~ubject to ~he
...... ~. ~llo~in~ condiilons i
The above described sanitary facilities ere disapproved for the follo~ing
Approval lo valid for one year follo~ing the da~e of approval.
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