HomeMy WebLinkAboutT12N R3W SEC 14 Portion of Section 14 has been SubdividedBeC II '
Departi;~ent of Ep, vircn'entai 0ua'J
3330 %" Street, Anchora9e, Alaska 99503 274-456]
Date Received
T~me of Inspection /0,'o0 ~ /~'
Approval requested by:
· ,,dur~:
REQUEST FOR APPEOVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
2. Property Owner: ....
Mailing Address:
3. Legal Description: b/4~,,~¢,,,~/~c~ /~ %/~ ~
5. Type of facility to be inspected
6. Well Data:
A. Type_~ ~.~-,~- ~'-~- ,~ B. Depth
C. Construction ' ' '
. ~/?,i~xL' '~('~dc~'~ D. Bacterial Analysis
Sewage Disposal System:
A. Installed /~//Z~73 B. Installer ~,o~ ~
C. Septic~Tank: 1. Size ~Pooo 2. Manufacturer
D. Seepage Pit: 1. Absorption Area /D%f 2. Material
E. Disposal' F!eld: Total length of lines ~
Distances:
A. Well to: Septic tank /¢~8~-~-¢ , Absorption area
Nearest lot line , Other contamination
B. Foundation to septic tank
Sewer Lines
Absorption area
C. Absorption area to nearest lot line
Page 1 of two pages
t0-034 (1i74)
3330
GREATE~ AHCHORAGE ARE,~, BOROUGH
Department of Environln~i;tal Quality
"C" St., Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATF_,R FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: Edward WilliaM, Nettleton
Mailing Address: S~A Box 55 (99502)
3. Name of Buyer: .....
FHA CONV XX
Phone 274-1122
Hailing Address:
4. Name of Lending Institution:
Mailing Address: Bo× 4-2090, Anch.
5. Name of Realtor or Agent: ....
Mailing Address:
D~y Phone
The ~irst National ~ank of Anchorage
99509 Phone 274-1521
Phone
Legal Description: Metes & Bounds
Locati on: NHN Abbott Road, Anchorage
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings
If Individual, depth of well
9. Sewage Disposal. System
,yp~ oF System: Public Utility
If Individual, date of installation
Duplex
presently
No. Bdrms. 6
Individual XX
served 2
Individual (on-site)
GREATER :ANCHORAGE:; AREA BOROUGH
3330 C STREET
ANCHORAGE: ALASKA 99503
r)EPARTMENT Of ENVIRONMENTAL. QUALITY
AL,, .A DEPARTMENT 01: HEALTH AND SOCIA/SEI,
DIVISION OF'iPUBL C HEALTH ~ob~o
IND V~ DUAL AND SEMI-PUBLIC
BA.CTERIOL, OG ICA:! WATER ANALYSIS
E] Salisfactor y
E] Questionable
[] sa~m;)le too long in transit; sample should nol be over 48
ADDRESS '~ ·
o~r SOURCE~ ~?E Fi,~ ,~ 9 ,i :!
.Z~CODI__ / Z (,
///'/!, ' ' ,4_
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
DATE COLLECTED /
MATERIAL: Budding Sewer
C] Ploslic Joint Material Type
GENERAL: Does Wmer Become Muddy or Discololed?
[] Cast Iron [] Wood [] Tile [] Fibre [] Asbeslas ,
[] Yes [] No
REA[) INS'rRUCI'IONS
2'1 Flours
ON
REVERSE SIDE
BEFORE
06.1220 Chi
Rev 1973
D~,,~,~,~,,,e~,./~/~ ,.//?/
48 Hours
!BACTERIOLOGICAL WATER ANALYSIS RECORD
COLLECTING SAMPLE
Reporled by
E] gotllo broken in Ironsil, please send new sample
SANITARIAN'S REMARKS
48 Brs._
