HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 30~ ~
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GAAB. HDi~
GR[~,,1'ER ANCHORAGE AREA BOROUr~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE. ALASKA 99501 279-:251
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS
PHONE
SEPTIC TANK:
DISTANCE FROM WELl ~rj,~
LIQUID CAPACITY ,.~, ~-"~"9 GALLONS.
MATERIAL ~ NUMBER OF /
.COMPARTMENTS
~/~ / '~ '7'~' LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH.__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER. __OR WIDTH t~' LENGTH / C''
, DEPTH
LINING MATERIAL C"~-t~'~ D~SIANCE FROM WELL BUILDING FOUNDATION.
NEAREST LOT LINE /~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) J'~) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FRO WELl , OF LINES
NUMBER OF U~ES
ABSORPTION AR~,,,...~..~,,'~ SQ. FT. LENGTH OF E~CH ~INE
DEPTH: TOP OF TILE TO ~:INISH GRADE,
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILF
~,~ DISTANCE FROM WATER
WELL: TYPF 14, DEPTH . BUILDING FOUNDATION, SAMPLE . NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE. , lANK , SYSTEM , CESSPOOL · SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DAIE
GREATEF NCHORAGE AREA .r' ROUGH
IIEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. ~'~'~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT /~'~//~f/~"j ~/.~/4 (...
· RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY 7
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS
LOCATION OF INSTALLATION
, SEEPAGE PiT , DRAIN FIELD '~/
,OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~/t /~c~.~/' , PERMIT TO INSTALL A ,~-~-~-4
/
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE '"'~"~) TYPE ~, SEEPAGE AREA TYPE ~-,
" OIAGRAM OF SYSTEM '/
DISTANCES:
above des~ibed system is in accordancc with said codc. '~/~2" ~ bt~ ~4.~. ~~>/
BOROUGH
( ~REAT£R ANCHORAGE AREA
HEALTH DEPARTMENT
. 32? EAGLE STREET
ANCHORAGE, ALASKA'99501
CASE
Performed For ,p,,~.} k~ ;~h~ Date Performed
This Fcrm Retorts a. Soils~o~ , t.-- · .Percolation Test
Depth
Feet Soil Characteristics
Was Ground Water Encountered?,
If Yes, At What Depth.. . .'c/~
Readlng Date Gross Time
Locat ~cn Sketch
Net Time Depth To ~20
Net Drop
Proposed Instal x~on: S~epage Pit ~.' ? Drain Field j/ ~
Depth Of Inlet, ,?~ ~' Depth To Bottom Of Pit Or Trenc~I ~,~
Test Performed BM: ~*"fr ~
Data Certified By:_~.c-,,~,~'