HomeMy WebLinkAboutT12N R3W SEC 13 Lot 40B - Lot No Longer ExistsLo-r'
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GREAFER ANCHORAGE AREA BOROUGH
of Environmental Quality
Anchorage, Alaska 99503 274-4561
~ Date Received ~l-
Time of Inspection ~'~
Date of Inspection
1. Approval requested
Mailing Address:
2. Property Owner: ~-.~L~
Mailing Address'
3. Legal Description:
4. Location:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Phone:
5. Type of facility to be inspected ~l ,],:1~ ~m~F'F~,~ NO. of bedrooms
6. Well Data: ~
C. Construction
Sewage Disposal System:
A. Installed ~°lqLI- ~ B.
C, Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E, Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
D. Bacterial Analysis
Installer
2. Manufacturer
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line __
2. Material
, Sewer Lines _,
EQ-034 (1/74) Page 1 of two pages
P~ge 2 of two pages - Re st for Approval of Individual ~ er & Water Facilities
Legal Description !Z~__~.~ ~ 3h~o~l') (~b~ '~ LIL~ ~2~,/.~
Comments
Approved .~ /~<~-~/ Disapproved Date /~/~/~_~_/
~ Approval Valid for one year from (late signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 'C" Street, Anchorage, Alaska 99503 - 274 4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
Type of Inspection: CMRO
Property Owner: ~. ~ /'~z Z~
. VA FHA
CONV //
Mailing Address:
Name of Buyer:
Day Phone
Mailing Address:
4. Name of Lending Institution:
Day Phone
Mailing Address:
\\,
Name of Realtor or Agent:__
Mailing Address:
Phone
Phone
6. Legal Description:
Location:
7. Type of Facility to be inspected:
8, Water Supply
~'~7/~ No, Bdrms. ~
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well /A~? ~
Sewage Disposal System
Type of System: Public Utility
Individual
Individual (on-site)
If Individual, date of installation ~/~(-Z ~ ~,/
EQ 037 (1/74)
DATE
DF '~RTMENT OF HEALTH AN[) WELF
DIVISION OF PUBLIC HEALTH
BACTERIOL061CAL WATI:R ANALYSIS
OFFICE
NAMF
ADDRESS
CITY
Records in Ihis office indicate Ibis WATER RUPPLY lo be of:
GENERAL: Does Waier Become Muddy Or Discolored? D Yes [] No
SANITARIAN'S REMARI(S
[] Of Well [] Olher- --
PURPOSE OF EXAMINATION: IRness Suspected? D Yes J~ No
READ INSTRUCTIONS
ON
REVI:RSE SIDE
BEFORE
COLLEC'rlNG. SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Brilliant Green
24 hours
48 hours
EMR.
Laclose Brolh, 24 hrs.
MF results
· om J
AGAR
Ro~onod I,y ::7
_Dole