HomeMy WebLinkAboutCREEKSIDE PARK #1 LT 63
W ·
It ~ t~e r~on~bi~ ~.~ owner.or
. LE~E~O:
~T SURV~ ~RTIFICATION e Ir~ Pi~
' ' · Stol Pin
Lot~, Block~ ' ~ Sur~ Hub
A~r~e, R~~, ~nct, AI~ REVISIONs
GREATER ANCHORAGF ARFA BOROUGH
Department of Environmental quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
'~/J'~ ~~'~ ~L ~¢~..~J Date Received ~-//- 7~
Time of Inspection l o'..~.~ ~
1. Aopro,,al Requested By:
Address:
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATfR FACILITIES
FOR
U
5. Type of Facility to be Inspected:
Number of Bedrooms:
6. Well Data:
Phone
A. Type
B. Depth
C. Construction
D. Bacterial Analysis
Sewage Disgosal System:
C. Septic Tank: 1. Size . . ~anufacturer
D. Seepage Pit: 1. Size~~2. ~aterial
Total Length of Lines
E. Disposal Field:
Distances: .~ ~~
A. Well To: Septic Tank
Installer
, Absorption Area
· Sewer Lines
, Nearest Lot Line , Other Contamination
B. Foundation to Septic.Tank ~%~-~[(~' Absorption Area
'Request for Approval of I~divtdua] Sewer & Water Facilities--
Page Two
9. Comments:
Aonroved ~_Disapproved_ ..... Date ~//~/~
Ap?~_ova? Valid for One Year From Date Signed
Greater Anchorage Area Borough, De,nartment of ~-nvironmenta] Quality
DIAGRAM. OF SYSTEN~,
I certify that the information contained in this request for approval to be a true
and accurate representat].on of the subject sewer and water facilities located at:
Signed Date