HomeMy WebLinkAboutH J PIKE LT 42
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
PHONE: D ,->,._~_/,~
/'7. >' Z'"~.n. / PHONE
PROPERTY OWNER: ~t~/.I)~.~+-~-~d~
TYPE FAC]LZTY TO BE
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NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE
B. DEPTH
D. CONSTRUCTION
E. BACTERIAl. ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
2. AGE
3. MANUFACTURER
4. INSTALLER
o
APPROVAL REQUESl FOR SEWER & WATER FACILITIL
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
WELL TO SEPTIC TANK
WELL TO SEEPAGE PIT
WELL TO SEWER LINE
WELL TO PROPERTY LINE
WELL TO OTHER POSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
DATE: DATE:
~/ /
APPROVAL VALID FOR ONE YEAR FROM DATE sIGNED./
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALIT'