HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 27
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GR~.~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT ~ ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION/~'~.~'~Z~
SEPTIC TANK:
MAILING
ADDRESS ./'~- ~]
LEGAL DESCRIPTION
DISTANCE FROM WELl ~"/~/~-~ ~ ~
LIQUID CAPACITY //0 ~ ~ GALLONS.
MATERIAl. ~/-~.~/~'~C'~-~--"" NUMBER OF /
COMPARTMENTS
~ "f~' ~ '~'~' LIQUID
INSIDE LENGTH / INSIDE WIDTH ~"'~' DEPTH
NUMBER OF PITS // ~OUTSIDE DIAMETER OR~""~ LENGTH______._~, DEPTH
TILE DRAIN FIELD:
DISTANCE FROM WELL/~/~'~/~2/~~, ~ , FOUNDATION~, NEARESl LOT LINF
NUMBER OF LINES 3 DISTANCE BElWEEN LINES '~ · TRENCH WIDTH
ABSORPTION AREA ~"~/~- SQ. FT. LENGTH OF EACH LINE /~----~ "~' "~
DEPTH: TOP OF llLE lO FINISH GRADE~ DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH ·
OF LINES /~?~' .
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: TYPE~'~'~' ~¥-~' ~' DEPTH ~,/DISTANCE FROM ~/ WATER
, BUILDING FOUNDATION SAMPLE ~ , NEAREST
LOT LINE / NEAREST ~/SEPTIC ~ SEEPAGE ~ ~ OTHER
, SEWER LINE ~ ., lANK , SYST~ , CESSPOOl , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
GREATEF'"'ANCItORAGE AREA 'gROUGH
IIEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT/--'*TtZ'~,/~'
RESIDENCE ADDRESS
~ LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK,
MAILING ADDRESS 73'~'~'/'t"/G'. -~,,~t PHONE NO.~7
LOCATION OF INSTALLATION
, SEEPAGE PiT , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY ~c~'.~t~-~ /'ta'~.~t.c: ~'7'3't',¢~,~
PERCOLATION TEST RESULTS /~ d',,__( ANTICIPATED DATE OF COMPLETION BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
SERVEAS ~II ~~ .PERMTTO NSTALLA.~
THIS IS TO
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
5~( '~
. SE~IC TANK SIZE/~ TYPE ,~.~,~SEEPAGE AREA -
DIAGRAM OF SYSTEM
DISTANCES:
DATE ~' / APPLICANTS SIGNATURE