HomeMy WebLinkAboutPALOS VERDES BLK 5 LT 12
l. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Co O.
3~ Legal Description:
4. Location:
5. Type of facility to be inspected
6. Well Data:
'Phone:
Phone:
e
No. of bedrooms
A. Type
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank: 1. Size
D. Seepage Pit: 1. AbsOrption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
B. Installer
2. Manufacturer
2. Material
B. Depth
D. Bacterial Analysis~/~,~ ~
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines ,
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
~Page 2· of_ t~wo pages - Re~.~;t for Approval of Individual F~,r & Water Facilities
Legal Description L./~. ~ ~ 7~/~ ~//2-~C/~ ~x/~,
comments
~ Approval ~Valid for one year from date signed ~z
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
ccurate 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 274=4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: ~. ~_~ .~} O~ ~'F~-
Mai-ling Address: ~j~,~) ~0~~, ~
3. Name of Buyer:
o
FHA
CONV ~
Mailing Address:
Name of Lending Institution:
Day Phone
Mailing Address:
Name. of Realtor or.Agent:
Mailing Address:
Phone
Phone
o
7. Type of Facility to be inspected:
8. Water ~uppl. y
Type of Supply: Public Utility
~( No. Bdrms.
Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility __~ Individual (on-site)
If I. ndividual, date of installation
EQ-037 (~/74)