HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 5 (2)
GAAB. HO-I
GRr~-RTER ANCHORAGE AREA BOROJtG~H
t i HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WEL~',/~e-,~-''~ ~ )
LIQUID CAPACITY _/"~'2 ~')~ GALLONS.
PHONE .'~ ~.~
NUMBER OF j
MATERIAL ~ ! ~"~1,/~'~'-"~~w COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH ' ' DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMEIER
__OR W~DT.
--
TOTAL EFFECTIVE ABSORPTION AREA ~ALL AREAJ
TILE DRAIN FIELD:
DISTANCE FROM WELl ~"'"'"''"'""~ FOUNDATION .,NEAREST LOT LINE.
ABSO.~,TJON AREA S~H OF EACH LINE
/
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
., OF LINES
..../~FFECTIVE
.DEPIH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILF
~ DISTANCE FROM WATER
WELL: TYPE DEPTH " · · BUILDING FOUNDATION. _SAMPLE
NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE, . TANK ~ . SYSTEM , CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES:
NEAREST
OTHER
SOURCES
' ~PPROVED~
GAAB-HD-2
GREATEr%ANCHORAGE AREA t~OROUGH
IIEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
C.~e No. ~0 ¢
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
,., ~/..~? ~'.":"/r/~- g..7,~.
NAMEOF APPLICANT,,~"~'~'t k~ C,O~--~¢X~IJMAILING ADDRESS -'~'~'~'~'~'~'~'~'~¢¢.,/ ~z ~*~'*-I~-ONE NO.__.,,___.,.,__,,
RES,DENCE ADDRESS LDCAT,ON OF ,NSTA'~,T,DN ~--,~,,/~£ ,¢~ ~/
LEGAL DESCRIPTION ,," ~.-OT ~" "~e t~- 8
APPLICATION TO INSTALL: SEPTIC TANK ~ ,SEEPAGE PIT
DRAIN FIELD,
To SERVE T.E FO.LOW,NG FAC, L,','~ .5' ~ .~/~ r.,"',
F~.A. CED T.RDUG. .- '"~' ~ TO BE .NSTALLED "¥
~'/', OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
TH,S,S TO SE.VE AS ~, C',~i~ ~..,~ .PER.. TO ,NSTALLA
~,,',
AS DESCRIBED ,ELOW, SIZE DF UNIT TO ,E SERVED ~"'~ ~ p~ r~
· SEPTIC TANK SIZE ~TYPE ~E~/At'~JT SEEPAGE AREA~TYPE v ¢- $~'~¢L, DIAGRAM OF SYSTEM ~7~'-
DISTANCES:
H AUTHORITY
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that thc
above described system is in ac, cordancc with said code.
DATE APPLI CANTS SIG