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:
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MISCL. INFORMATION:
DRILLER'S NAME /~'~'~(' ...... ("
