HomeMy WebLinkAboutO'BRIEN BLK 5 LT 6
IN!)'[tZ]'DUAf..."-;E¢IU.'R & WATER FACZLI'rIEs
3. Legal Oescription: Z-~ , 0
4. Location: (
5, Type o'f Facili'bv
Number of Bedrooms:
6. Well Data:
_" . _
- ._,,~(~ ~ -- .. - ~.~ ....~ /-j' .
A. Ir, stalled /
Seepage Pit:: ].. .SJ.z,a ............
Disposal F~el.d: Tot:al
8. i)tstances:
A, Well.-fo'- Septic Tar, k...~..?z~../2._? .... , Absorptio,, A'rc, a_./_.<).~'_....(. ........ , Sewe~ Lines
/0 ~ , Naa~:erd: Lo!: l,J. na j~ Ol:.b~v Cot-~can~t, lrm~ /'/~ .
Co Ab~iovption At'aa h,' l~lea-ceat Lot: Line o~ ~ ,
/
Ap~ovaJ Va)id fo~.' One Y,-~aF }:',.-n:, ,.Da:re
Greater Ancho~aqe At'es }~orou~h, Oera'rU~er',l:
certify P, hat 't;he informati{m c(mi;;~dned in this Fequest .... at} ?:oval to be a t;~me
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Rece&ved~.~-~
T&me of Zns~ection
Date of Insoectlon
pr.G~IPCT FOP APPROVAL OF
INDIVIDLIA!. SEWER & WATER FACILITIES
FOP
Approval Requested ~y:
Address: ~ :,,. ,::';*~ :~¢~['%!~tJ";t LJ ;?,f:5
Property C~ner:
Legal Description:
Phone:
Phone:
Location:
Type of Facility to be Inspected:
Number of' Bedrooms: i::.~ ¢1'
?~el] Data:
A, Type ,~y't]l ~_; g. Depth
Co Construction D. Bacteria] Analysis
Sewage Disposal System:
A, %nstal].ed
C. Septic Tank:
D. Seepage Pit:
2o Disposal Field:
B. Installer
l, Size]Ui~,"i 2. Manufacturer
1. Size 2, Material
Iota] Length of Lines
Distances:
A. We]l To:
Bo
Septic Tank ..... ;,.~j~'._~____., Absosption Area
, Nearest Lot Line , Other Contamination
:~+ . · .:,+
Foundation to Septic Tank ~, AbSorption Area__
Absorption Area t.o Nearest Lot Line
, Sewer Lines
Refn]est, for Ao,,oroval
Pa,~e Two ~
9, .Comments: ~'
of ..... ividual Sewer & Water Facilitt~
Aporoved Disapproved Date
Approval Valid for One Year Fro~ Date St¢ned
Greater Anchorage Area Borouoh, Degrtment of Environmental Quality
D~AGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the suol,,ct sewer and water facilities located at:
Signed Date