HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 25PI ELc
/~,~ ~7'"/'/ 327 EAGLE ST.
ANCHORAGE AREA BOR,~I~GH
HEALTH DEPARTMENT
ANCHORAGE, ALASKA 99S0! 279-25! I
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WELI~~'~/.
LIQUID CAPACITY ~ ~:~
MATERIAL
GALLONS.
.LEGAL DESCRIPTION :~_~7'" ,~'.. ~/~'/--~'J / ~/~
COMPARTMENTS.
/ ~ / LIQUID
INSIDE LENGTH /~ INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PIS ~ O R wJl~l~"'"'""~ LENGTH ,DEPTH
LINING MATERi~ L~.--/J'~ ~~NDATiO N.-
NEAREST LOT LINE . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROMWE~'~', ../~?(~ FOUNDATION //~ '
NUMBER OF LINES ~ DISTANCE BETWEEN LINES
NEAREST LOT LINE
.TRENCH WIDTH
TOTAL LENGTH
· OF L,NES
IN. TOTALEFFECTIVE
ABSORRT,ONAREA ~S'-~ SO. FT. LENGTH OF EAC. L,NE /g')~' '. /,'~ ~':Z' .' /~ ~
DEPTH: TOP OF TILE TO FINISH GRADE ,DEPTH OF FILTER MATERIAL BENEATH TILE ~ ~ IN, ABOVE TIL~ ~
WELL: TYP . ~ DEPTH ~ ,BUILDING FOUNDATION. ~ SAMPLE , NEAREST
OIHER
/ , CESSPOOL *~ , SOURCES
DISTANCE FROM
NEAREST SEPTIC SEEPAGE
LOT LINE ~ .. SEWER LINE ~ TANK ~ , SYSTEM
DIAGRAM OF SYSTEM
DISTANCES:
DATE
'1
APPROVED
GREATER~X_NCHORAGE AREA Y'~ROUGH
., ~ tlEALTI! DEPARTMENT //
327 Eagle St. Anchorage, Alaska 99501 279-2511~~
/2..
s,w^G~ o,s.os^L svs..a - ^.L,C^,?. &
/
NAME OF APPLICANT ~a~ ~DM~" MAILINGADDRESS~Z~ . PHONENO.
' LEGAL DESCRIPT~
APPLICATION TO INSTALL: SE~IC TA~~ SEEPAGE PIT , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACIUTY ' ~~~~ ~L~ ~ ~A~//
PERCOLATIO~ TEST RESULTS ANTICIPATED DATE OF COMPLETION ~ g~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
ASDESCR.EO.LOW/S,'E Or DN,TTO.E SERVED
, SEPTIC TANK SIZE /Z~)~)~) TYPE~"7~/~-~/-/~T'-SEEPAGE AREA TYPE ~'/~'"~
'~4*.J~-DIAGRAM OF SYSTEM
DISTANCES:
I certify that I am familiar with the requh'.c, ments of Greater Anchorage A~ea Borough Ordinance I~o. 28-68 and that the
above described system is in accordance w,th said code. ~.)~ ~ I ,<~ b~' ]~ W/~)~,/~ ~ r~
:REATK`R ANCHORAGE AREA BOROUGH
HEALTH DEPART:.!r. NT CASK. #. .~'-~
327 r. AGLE £TRK`ET ''
ARCHORAGE~ ALASKA 99501
Dep:h
Fee:
7,,
Was Ground Water Encountered?_~,~
I-~ Yes, At What Dept,h~7~',,~ 0,
Reading Date Gross Time
Location Sketch
Net Time Depth To H20
Net Drop
Proposed Instal~Seepage Pi:
Drain Field