HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 41
GR~-"~TER ANCHORAGE AREA BORO?*""~H
' HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION~~ ~ / LEGALDESCRIPIION ~/
SEPTIC TANK:
DISTANCE FROM WELL .~7~"~,'~ 'E-/ d
- MATERIAL ~__ ~/~ ~:)/[./7' NUMBER OF
COMPARTMENTS
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE,
OUTSIDE DIAMEIER. OR WIDIH
· DISTANCE FROM WELl
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH . DEPTH
, BUILDING FOUNDATION__
SQ. FI'.
TILE DRAIN FIELD: ·
/
/ ,
~~ ?' //~1 TOTAL LENGTH/.,~---) '-
DISTANCE FROM WELL__ . FOUNDATION , · NEAREST LOT LINE__ , OF LINES
IO
NUMBER OF LIN~S ~ DISTANCE BETWEEN LIN~ .IRENCH WIDTH ~ IN. TOTAL EFFECTIVE
ABSORPTION AREA ' ~ u ~ SQ. F~. / LENGTH OF EACH LINE
DEPTH: TOP OF TILE T~ FINISH GRADE ...... ~' .DEPTH OF FILTER ~TERIAL BENEATH TIlE
~ ~ DISTANCE FROM · WATER
WELL:
TYPE . DEPIH ,BUILDING FOUNDATION. ~SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE. , lANK , SYSI~ , CESSPOOL , SOURCES~
DIAGRAM OF SYSTEM
DISTAN,~ES:
,
o**~*nD-= , GREATEhANCHORAGE AREA ROUGH caseNo.
'~ ' · tl EA LTl I D EPARTM EN T
327 Eagle St. Anchorage, Alaska 99501 279.2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEFTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED TJ;IR~ U G H ~
PE-R~EST RESULTS
LEGAL DESCRIPTION
O~,~t,~rr'~)MAILING ADD,ESS 7/OD ~.F.. 01"/~ PHONE NO.~~
, SEEPAGE PIT ~ , DRAIN FIELD. , OTHER
ANTICIPATED DATE OF COMPLETI~ ~ ~ ~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
TH,S,STOSERVEAS ~/u. ~d~,~tar"4;. ERM,T TO ,NSTALL A
AS DESCR,RED BELOW. ~,~ o~,,fZo..~s~,v,,. ~ ~ ~~)"
.SE~IC TANK SIZE /~ TYPE L'~USEEPAGE AREA 7C~ ~/TYPE ~'~ ~.~
c o,~.A~ o~ svs~m
Health Authority
! certify that [ am familiar with the requirements of Greater .~nchorage Area Boroush Ordinance N9. 28-68 Ff~d that,,~he
above described system is in accordance with ~id code. ~ _ _ ~ ~_~ ~ ~ '7/~/~3 ~