HomeMy WebLinkAboutALDERWOOD BLK 1 LT 20
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3320 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received /
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
$. Type of facility to be inspected
6. Well Data:
A. Type ~_
C. Construction
?. Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
8. Distances:
A. Well to: Septic tank
Nearest lot line -~'~
B. Foundation to septic tank
C. Absorption area to nearest lot line
FOR
J~z~_~ ~-~ ~-Phone:
~.zZ,~>~x_~/ Phone:
~ No. of bedrooms
B. Depth
.. ~D. Bacterial Analysis ~.__~~7~~
B. Installer
1. Size 2. Manu~facturer
1. Absorption Area 2. Material
Total length of 1 ines
Absorption area , Sewer Lines
, Other contaminat'ion
, Absorption area
P~g9 ~f two pages - Request for Approval of Individual Sewer & Water Facilities
Legal Description
Approved ~ Disapproved Date
Approval Valid for one year from date signed ·
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
Percolatio~ Test ~esults
f. Percolation Test performed by
Use the reverse,side of this form to show diagram. Diagram should include
~he foil,owing information: pEoperty lines;.well location, house location,
~f~c tank location, disposal area location, location of percolation test,
a~ d~r. ection of ground slope.
9. The l,~[,~,.,~on on t¥:is form is true and correct to the best of my knowledge.
Signature of Applicant
T...~O BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
The above described sanitary facilities are hereby approved, subject to the
~6'llowin~ con~fons: ' '
Conditions: ~~
The above described sanitary facilities are disapproved for the following
reasons:
Appz-oval is valid for one year following the date of approval.
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