HomeMy WebLinkAboutNORTON PARK #3 BLK 1 LT 1
January 29, 1973
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Envirom~,~r~tal Control Officer
cc: VA AU,;,,intsCra'Clon
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental quslity
3500 Todor Road, Anchorage, Alaska 99507 279-8686
Date Received /~
Time of Insoection
Date of Insovctzon
REQUEST FOR APDROVAL OF
INDIVIDUAL SEiNER & ,tIATEI. FACILITIES
FOR
Aoproval Requested
Address:
Number of' Bedrooms
A. Type B.
C. Construction D.
Sewage Dtsoosal ~ '
Depth .........
Bacterial Analysis
A. Installed
Installer
C. Septic 'rank: 1. Size
2. Manufacturer
D. oeepag6 Pit: 1. Size
2. Material
Disposal Field: Total Length of Lines
Distances:
A. Well To: Septic Tank .............. , Absorption Area
Sewer Lines
, Nearest Lot Line
, Other Contamination
B. Foundation to Septic Tank
";. Absorotton Area
Absorption Area to Nearest Lot Line
Reque,£t for Approgal of i,...,ividual Sewer & Water Facflitie..
Page Two
Comments:
Aporoved .... ~/C. ~/t~k~-/ Disapproved
Approval Valid for One Year Fro~ Date Signed
Greater Anchorage Area Borough, Department of ~nviron~enta] Quality
DIAGRAM OF SYST~
I certify that the information contained in this request for approval to be a true
and accurate representation of the subject sewer and ,~ater faciltt:[es located at:
Signed Date
REQUEST FOR APPROVAL OF
>/2/ INDIVIDUAL SEWAGE AND WATER FACILITIES
. (Fill out in Triplicate) .....
person requesting approval_ J6D~ ~{7-&~/~"~
~ 2. 'N~e of p~ope~ty~ owne~ ~.~ ,_~/p~.~" _ .......................
Well data:
b. Depth
c. Casing Size_ .
d. Distance from well to closest existing or proposed:
1. 8ewer line
3. Seepage Area__
4, Cesspool,s_ :~ .
5. Property Line ~dT~'/~FZ
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn~ drainage ditch, etc.~ ....... ~,_.~_-'~ ........... .
Sewage disposal system,
a. Age of system ._ .~., C //Jr j~:d/~~7'~'
b. Septic tank capacity in gallons .
c. Name of septic tank manufactu~e.r .
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type ...........
1, Distance to property., line to house foundation
a, Perco3.atlo~ Te~t Yesults
se the reverse .side of this f"o~m to show diagram. Diagram should include
%~-~he following information: p.~operty lines; .well location, house location,
~ptic tank location, disposal area location, location of percolation tes~,
aD~ direction of ground slope.
9, The Information on this form is true and comrect to the best of my knowledge,
ignature of Applicant Date Signed
,BE ,FI!,LED OUT BY H.E.A~.T!DF.~A~T,.:ENT PE~S_~ONN~EL
above described ~anita~y facilities are hereby approved, subject to the
Conditions:
The above described sanitary :facilities are disapproved for the following
reasons:
~f~-a~ - ,." ~. ~Date
/
App~al is valid fo~ one yea~ followln~ the date of approval.
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