HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 31
GAAB. HO, I
GP'--&.TER ANCHORAGE AREA BOROI~'~H
~ : HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MA UNG t)
ADDRESS/UI _~'C~J,IP.-e~. /,r T~,,T PHONE
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL--MATERIAL ~'-~J~'s'e~--~ NUMBER OF
COMPARTMENTS //
?,) L,OU,O
LIQUID CAPACITY '"~-~'~ GALLONS. INSIDE LENGTH. .INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS (~
LINING MATERIAL _(/~I~/~'~J~-
NEAREST LOT LINE /~
OUTSIDE DIAMETER -- OR W~IDTH ,~ , LENGTH J . DEPTH
fL; ,
~'~ , O STANCE FROM WELL~, BUILDING FOUNDATION
, TOTAL EFFECJlVE ABSORPTION AREA ~ALL AREA) ~ ~ SQ. FJ.
TILE DRAIN FIELD:
DISTANCE F/~W ELI ~
NUMBER O~F LINES,~~ANCE BE/WEEN LINES
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
NEAREST LOT LI~ . OF LINES
N~CH WIDTH '~ ~v~FF ECTIVE
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DEPTH: TOP OF TILE TO FINISH GRADE
WELL: TYPE~ DEPTH ~* DISTANCE FROM WATER ~
, BUILDING FOUNDATION. ~/"~'- SAMPLE - . NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ~ SEWER LINE j>/e,¢...-. TANK W,~.~ . SYSTEM &e/~.~ . CESSPOOL ~ . SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE __1~/////~0 APPROVED
o.^B-,,.-. GREATEI~ANCHORAGE AREA ~OROUGH c,.~o.
IIEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SE~IC TANK /, SEEPAGE PiT ~ /, DRAIN' FIELD ~ ', OTHER
TO SERVE THE FOLLOWING FACILITY ~ ~.
FINANCED THROUGH ~-~ TO BE INSTALLED BY.
~/~.-~
~ TEST RESULTS ~UT~C~P~TED ~TE OF CO~P~ETmU
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
. SE~IC TANK SIZE 7,~ TYPE~EE"A~E AREA~/~ ~TYPE DIA~RA~
/ =~ / , , ~.-,
~ /
DISTANCES:
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 accordance with said code
DATE APPLICANTS SIGNATURg~-
f'~C~^TER ~CHO~ APZA BOROUGHS'5
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE #, , ~
Date Performed ~fT~ IqTQ ,
..Percolation Tes: '
Was Ground Water Encountered?
If Yes, At What Depth_
Reading Date Gross Time Net Time
Location Sketch
I I
Depth To H20 Net Drop
Frcposed Instal~$eepage Pit / Drain Field
Depth Of Inlet / '~
c~w~r)~?c. .,, -~- Depth To Bottom Of Pit Or Trenn~
Test Performed