HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 10,OIq
075"
G~'anTER ANCHORAGE AREA BORG,
D~..RRTMENT OF ENVIRONMENTAL nUALJ.
3500 TUDOR ROAD ANCHORAGE, ALASKA 9~$07 27~-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
GALLONS.
MATERIAL ~'J~ 'J~- / NUMBER OF ~._
.COMPARTMENTS
INSIDE LENGTH INSID~ WIDTH~DEPIH
SEEPAGE SYSTEM: SEEPAGE Pit:
NUMBER OF PHS / OUISIDE DIAMEIER -'"' OR WIDTH
LINING MATERIAI~')./- ~'/t"(,,~' ~'/~A"I~T/ZTM . DISTANCE FROM WELL
NEAREST LOT LINE ~"~/) / % //4~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
., LENGTH ~ , DEPTH ~ t
, BUILDING FOUNDATION /9 ,J
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OTNES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, NEAREST LOT LINE
DISTANCE BEIWEENLINES '% TRENCH WIDTH
SQ. FT. LENGTH OF EAC LIN'~
1OTAL LENGTH
. OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILLER MATERIAL BENEATH TILE__IN. ABOVE TILE
WELL:
c -
TYPE 0~/11t~0~) _ DEPTH
~ NEAREST ~ SEPHC
LOT LINE , SEWER LINE ., TANK
DISTANCE FROM ~ WATER ~
BUILDING FOUNDATION.__SAMPLE , NEAREST
.- SEEPAGE ~ OTHER
., SYSTEM , cesspool , SOURCES
DISTANCES:
DIAGRAM OF SYST.~
~.~AME OF APPLICANT~. ~~ MAILING ADDRESS~/~ /~, 7~ - PHONE NO.
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SE~IC TANK ., SEEPAGE PIT , DRAIN FIELD. , OTHER
TO S~nVE T.E ~OC~OWmO ~mUTV,
~~ TEST ~ESU~TS ANTmmTEO OATE OF CO~P~[TmN ~'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS//~'~' lJ~'.~z~/'/[/~'' , PERMIT TO INSTALL A ~/~' AS OESCRIBEO BELOW. SIZE OF UNIT TO BE SERVED ~ ~-
. SE~IC TANK SIZE ~ ~ TYPE ~SEEPAGE AREA ~ ~YPE
'/
DIAGRAM OF SYSTEM
IISTANCES:
/
I certify that I am familiar'with the requirements of Greater Anchorage Area Borough Qrdinance No. 28-68 and !St thc .
above described~./system is jrt accordance with said code. ~7'
DATE ~-//~///~d APPLICANTS SI GNATU"x
/
HgALTH DEPA~TtIENT
327 EA~LIZ STREET
ANCHORAGE. ALAZKA 99501 ·
c^s£ #
Performed For ~n~ ~u/~ Date Perfo~ed
LeEal Description: Lot _~lock ~ 'Subdivision Cr,~,~t,.l!
This Fcrm Re~orts a: So~ls LoR . p-' .... Percolation Te~ '
Depth
Feet Soil Characteristics
a.J ~e~ ~1~t,¥~1
loose. The
~ 6a~ ~Ffh
~h~ '~o~) silt
Ola~
Was Ground Water Encountered?
If Yes, It What Depth_
Reading Date Gross Time Net Ti~e
Location Sketch
~ I
r,
Depth To H20
Net Drop
~' Yroposed Instal~Seepage P. it.. /
t Depth Of_Inlet , ~, Depth To [Iottom 0 Drain Field
',~ COM~tENTS: ~-~ ~-7 .~ ~ ~_~,/,. f Pit Or ~nc~ ~3 m
Test Perfo~oed By:~Derec~)
Data Certmea