HomeMy WebLinkAboutT12N R3W SEC 22 Lot 29
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road· Anchorage, Alaska 99507 279-8686
Date Received~
Time of Inspection
? >;~ v~J ~ / Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SE~ER & WATER FACILITIES
FOR
Type of Facility to be Inspected: .
Number of Bedrooms: ~'/
~ell Data: ~~~
C. Construction
8. Depth //~:
D. Bacterial Analysis
7, Sewage Dts6osal System: ~:.- ~-~c'~
A. Installed z/x/- //,~o~ B,
~-C. Septic Tank: 1. Size / 2 ~-'~, 2.
Installer ~¢.'
Manufacturer
"D, Seepage Pit: 1, Size ~o~/[?/ 2, Material
E. Disposal Field: Total ~ength of Lines
Distances:
A. Well To: Septic Tank
· Absorption Area
· Sewer Lines
, Nearest Lot Line
· Other Con'tamination
B. Foundation to Septic Tank "~ Absorption Area
C. Absorption Area to Nearest Lot Line
GREATER ANCHORAGE ARE,q BOROUGH
Department of Environmental Quali,ty
3330 "C" St., Anchorage, Alaska 9950-3
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: MoOl~_ve~ WilZ±am F.
Mai 1 lng Address: %900 ~,ielson ~%;oeet
3. Name of Buyer:
Mailing Address: n/~ Day Phone
4. Name of Lending Institution: NATION/LT~ BANK O~ ~_T~ASI~
Mailing Address: P.O. Bo× 600, Ancho~ge~ Ak
5. Name of Realtor or Agent: n/~
Mailing Address: ~/~
~HA CONV ~ :
Day Phone 277-5594 -',
Pho'ne 272-%55,Z~ e~ 383
Phone
Legal Description: N132 ft. of Lt.29, S22, T12N, R3W, SM
L 0 c a t i 0 M: 000 Totem Ro~d
7. .Type of Facility to be inspected: ~ ~o. Bdrms.
8, ~ater Supply
Type of Supply: Public Utility Individual x~:xx
If Individual, number of dwellings presently served o~e
If Individual, depth of well _~60 £~.
Sewage Disposal System
Type .of S~stem: Public Utility
If Individual, date of installation
Individual
Novembe~ 1972
(on-site)
2eq,mst for Approval of Inoividual Sewer & Water Facilities
Pa~ Two
Annrov~d ~ ~ ~ /~ ~,~ Disapproved Date
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental quality
DIAGRA~ OF SYSTEM
I certify that the information contained in this request for approval to be a %rue
an~ accurate representation of the Subject sewer and water facilities located
Signed Date