HomeMy WebLinkAboutNEWLAND Block M Lot 12
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "c" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
1. Approval R~quested By:
Address~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
~ 07 '~.~--~c~.c_~ Phone:
2. Prooert¥ Owner: 2~,--~ Phone
Number of ~3edrooms: ~_~ '
6. Well Data:
C. Constructi on C~,/~,-, D.
7, Sewage Disposal System:
A. Installed /~o B.
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Size
Depth ,~ ,
Bacterial Analysis ~.
Installer
2. ~anufacturer
2. ~atertal
Total Length of Lines
Disposal Field:
Distances:
A, ',~]elL To:
Septic Tank
, Nearest Lot Line
Foundation to Septic Tank
, Absorption Area , Sewer Lines
, Other Contamination
'i> Absorption Area
Absorption Area to Nearest Lot Line
~ ' f'Requ~st, for Approval of"ln~divf(~ual Sewer ~ Wate'r Faefllt!~s~
· - Page Two
^pp't~_v~! Valid for One Year From Date Signed
Greater ^nchorage ^rea Borough, Dap~rtment of Environmental Oualfty
D'[AGR^M OF SYSTEM
I certify that the information contained in this request for appreval to be e true
and accurate represen'tatten of the subject sewer and water £ac[!tttes located et~
Signed Date'
L,/~ I I
,a ii
ii!
STATEt;I £NT
200i E. 88t¼ AVE.
ANCHORAGE, ALASKA 99502
George Hammond
8607 Vernon
Anchorage, Alaska
DA're on
h-4 E M O OFIARGES C~,EDIT$ BALANCE
BALANCE FORWARD
1~ SERVICE CHARGE ON PLEASE PAl
ALL PAST DUE ACCOUNTS LAST AMOUNT
IN THIS COLLIN~N
SREATER ANCHORAGE AREA BOROUGHx~j
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE #
Legal Description: Lot th Block__~.~_. S~i~islon~~I~__i __~u '
1his Form Reports a: Soils Log ~.~ - - - e~colatzon Tee{ -
Depth
Feet
Location Sketch
Reading Date Gross Time Net Time Depth To H20
ter~ola~on 'l',a~." I"/ ~,,~ -~--'"--"--"~ ____ ~
If Yes, At.What Depth
Net Drop
Proposed Instal~Seepage Pit Drain Field
Depth Of Inlet '~ ~,~__ '. Deptb~o Bo't~om Of ~i~ OP ' '
Test Performed B~..:~
oate :~