HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 3507 " I0
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
__ _ _ ADDRESS __PHONE
DISTANCE FROM WELLi~'Jd/'d(",, ./~?/"~ /"~.,~,,'.,..,4..--....---~-. NUMBER DP
_ _ MATERIAl ~ e.~,...~,~,~,~,~,~/- ~ COMPARTMENTS
SEEPAGE SYSTEM: SEEPAGE PIT:
LINING MATERIAl ~/ DISTANCE FROM WELL . BUILDING FOUNDAIION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT.
TOTAL LENGTi~,~/ /,
OF LINES ~,~f / ~
IN. TOTAL EFFECTIVE
TILE DRAIN FIELD:_
DISTANCE FROM W[~~, FOUNDATION J//O! NEAREST LOT LINE
NUMBER OF LINES ~ DISTANCE BETWEEN LINES~TRENCH WIDTH ~ t
OEPIH OF FILTER MATERIAL BENEATH IILE IN. ABOVE TiLE
DEPTH ~ DIS*ANCE FROM WATER
N~ARESI SEPIIC SEEPAGE OTHER
tOT LINE ~ , SEWER LINE ~ , TANK ~ , SYSIEM ~ ~ , CESSPOOL ~ , SOURCES~
DIAGRAM OF SYSTEM
DISTANCES:
DATE
APPROVED
GREATEr" ANCHORAGE AREA f"OROUGH
I I EA LTl! D EPARTM EN T
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~'?/~ l ~'~r/('Z c~ ~''
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK,
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS PHONE NO
LOCATION
OF
INSTALLATION
.
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /~//} ~/~t~t'~ . PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT~TO BE SERVED
.SEPTICTANKSlZE /~g""~ TYPE ,('4;,./_ SEEPAOEAREA
DIAGRAM OF SYSTEM
DISTANCES:
['certify that [ am familiar with the requ~ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code. /-,"