HomeMy WebLinkAboutFYFE BLK E LT 21 REM1-2-4 -lD
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received
Time of Inspection
Date of Inspection 1//j%�.?
REQUEST FOR APPROVAL OF
INDIVIDUAL SEINER & WATER FACILITIES
FOR
1.
Aoproval Requested By: MAZ 1)�,
Address; Q-L ram- A
Phone
2.
Prooerty Owner: 00-'' ric-
Phone :
3.
Legal Description: /cC/" 2/�� A
l
4.
Location: /-70,
5.
Type of Facility to be Inspected: Ag.�/�?����1 /✓ r�-r
Ll
1
Number of Bedrooms:
6.
Well Data: 1'� �"�_�0 Lcj
A. Type /�i„��'QCt' B. Depth
C. Construction •� C4046s1a 62D. Bacterial Analysis
r�
�'-/
7.
Sewage Disposal System:
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. ize 2. Material
E. Disposal Field: Total Length of Lines
8. Distances:
A. Well To: Septic Tank_ , Absorption Area Sewer Lines
Nearest Lot Line Other Contamination
C.
Foundati o Septic Tank Absorption Area
Absorption Area to Nearest Lot Line
Request for Approval of Individual Sewer & Water Facilities
Page Two
9. Comments e GLLi el
r
Aporoved / ?/ .1/ aZ_� �f C-�-,/ v`Disapproved
Date
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM!
I certiry that the information contained in this request for approval to be a true
and accurnte Yenrosentation of the suhiect sewer and water facilities located at:
Signed Date