HomeMy WebLinkAboutPALOS VERDES BLK 4 LT 9
3330 "C" Street, Anchorage, Alaska 99503
L ~
GR~/ATEB-ANCHORACE 6REA BOROUGH/
Depar~e'nt~of En¥5;ronmental QUal~y,~,' }.. ,
-274-~561., .... ,~ ~"'"~'
Date Received
Time of Inspection
Date of Inspection
FOR APPROVAL OF
~NDIV'ICU~£(..SEWER & WATER FACILITIES
FOR
O.
1. Approval requested by: ReeO~ ~'~o..~.~,./
Mailing Address:'~c~¢~l. z~C~ .~- ~.
2. Property Owner: ~, L~). ~,-'~-~
Phone:
Phone:
Mailing Address:
3. Legal Description:
4. Location:
!
5. Type of facility to be inspected
6. Well ~ata:
No. of bedrooms
A, Type
C. Construction
Sewage Disposal System:
B. Depth
D. Bacterial Analysis
A, Installed
B. Installer
C. Septic Tank: 1. Size .,
D. Seepage Pit: 1. Absorption Area
2. Manufacturer
2. Material
E. Disposal Field: Total length of lines
.8, Distances:
A. Well to: Septic tank
Nearest lot line
, Absorption area
, Other contamination
, Sewer Lines
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
LQ-034 (1/74)
Page 1 of two pages
Page '2 of t~wo, pages - R(,.?st for Approval.-of Individual ~=.~er & Water Facilities
~l Description ~-- ~ ~TZ-~ Y~2'//~ ~//~-/'~ ~7
Comments
Appro~:~ _~ Disapproved Date ,
Approval Valid for one year from date signed Ox/
Greater Anchorage Ar6a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I 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)
GREATER ANCHORAGE AREA BOROUGH._.
Department of Environmental Quality
3330 "C" St., Anchorage~ Alaska 99503 - 27q-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA FHA
2. Property Owner: ~-~_ ~-~-Q-
3. Name of Buyer:
Mailing Address:
4. Name of Lending Institution:
Mailing Address: Phone
5. Name. of Realtor or.Agent:
Mail i~g Address:
CONV ~
P,one
Day Phone
Legal Description:
7. Type of Facility to be inspected:
8. Water ~upply
Type of Supply: Public Utility ~ Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility ~ Individual
If Individual, date of installation
No. Bdrms.
(on-site)
EQ-037 (~/74)