HomeMy WebLinkAboutT14N R2W SEC 12 SE4 SE4 GP~ATER ANCHORAGE AREA BOROUG[ HEALTH DEPART~ENT <, ,' '~ 327 EAGLE STREET ANCHORAGE, ALAS,~. 99501 279-2511 / ~' ~ ! '~: ~ ~/~ ~,~ ~ INDIVIDUAL,SEWAGB ~D WATER FACILITIBS 5. Well Data: / A. Type B. Depth /q~/ ~/-- ,, / c. size ,,, ~i~,,~:,~::,:Y~'" D. Construction o~u E. Bacterial Analysis ~h Sewage Disposal System: Septicl. SizeTank (If homemade,~/~sh~, diagram~ on back) 3. Manufacturer ~/~/~- 0 1 Request for S¢ .3age Two ~e ~ Water Facilities R. Seepage Pit 2. Lining .Ad/~ C. Disposal Field 1. Number of Lines 2. TotaI Length Required Measurements A. B. C. D. E. F. G. H. Well to Septic Tank Well to Seepage Pit Well to Sewer Line Well to Property Line Well to Other Possible Contamination Foundation to Septlc Tank Foundation Seepage Pit to Property COMMENTS: APPROVED: DISAPPROVE~ DATE: DATE: APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED, GREATER ANCHORAGE AREA BOROUGH HEALTH DEPART~{ENT EDll70 by DOC CO, dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 JUL 1 1979 RECEIVED OWNEr OF ADDRESS KIND OF FORMATION: From From .---, From From / From?V From /'~ From From From From From From ~ F~om ~ F~om Ft to ~- Ft. ,,_'~/~L</,, :j~fti, y ~.7/ _ From Ft. rD.__Ft. Ft. to_ / ,~.,k.. Ft. -7~i/,,~ ~ ~.. (-///;' ~/~. From_ Ft. to Ft. Ft. to ~ '~ Ft. ~./-./t/ ~ ~'i'~/~/ From Ft. to Ft._ Ft. to /~, / Ft. / h-,,,/ , ~/~/_~ From Ft. · , ,,,, ..... vt, ro: .... Ft [ ~/Y~ ~rom_ Ft. to Ft Ft to/'d/':~r Ft.:L///Vct"/~",L/~:'[~//~/;'~ From Ft. to__.Ft_ Ft. to/~]?'~ Ft /'(Z~?:)~ 5~)//h/~/,.. From Ft. to Ft. , / /. A ........y~/-/~_/~ From Ft. to . Ft. to/'"55/ Ft.~-,A/J?~ ' ~t :~ ~' :'-7:., Ft. to Ft~ From Ft. to~.Ft Ft. to Ft. From Ft. to Ft. Ft. to Ft. From _Ft. to~ Ft. Ft. to Ft. From Ft. to Ft Ft. to Ft. From Ft. to Ft. to_ Ft. From Ft. to Ft. Ft. to Ft. From Ft. to Ft. Ft. to_ Ft. From~Ft. to Ft. Ft, to_ Ft. From Ft. to oft. MISCL. INFORMATION: DRILLER'S NAME /~'~'~(' ...... ("