HomeMy WebLinkAboutMEADOW BROOK Block 6 Lot 28
I~tLIN l C J PAL iTY OF AIqCIIOIRAGE
OF liEAI._-I!I AND EI,IVIRONHEhI'
]:, St:reeL, Anchora~ro, A]aska
2 64 - 4 7 20
PROTEC
9950]
ca'ce P, eceived: Re_E~p.b._e..E ._%3_ ~ _ .?. 7_7
ii2:
'J.' J me ~t 3: ~ .~ m
D a L e Da L: e
I .n s p I n s p
2. ]~roperty Owner: Eric S. Johnson Phone: 694-9734
Hailing Ad(1.~:ess: Post Office Box 722 99577
3, Legal De. sc]riptSorl: Lot 28 Block 6 Meadow Brook Subdivision
4;
Single Fami.l_y R(;r;idence; (x)
MulLip].o. Pam:i ly ke~,n_dcn<.(.: ( )
¢_,]_ ]3cdrooms: Four
Number oi! Bedrooms:
5.
Wail Syst-em: i.nd.lvi:]ua] Well ) Community/Public System (x)
Permit: ii Depth Of. Wo].] Well. I.,og o~t Pile ( )
Conskruc-hi. on Bact:erial Analysis
Sewage DJ.sposal Syskem: On--slt:n System (x) Public Uh.i].4ky ( )
Permit ~ ]insha].]_ed Install. er
Sepki. c Tank,.c'~'z,'. bianufachurer
Absorption Area ................... SoiLs Rate ............... Hcih~:.xJ.al ...........................
'7.
Disl;a. nces: Well to Se[)t:ic
[10 ':'" ·
o .Wt.r ~,:i.ll(2 i'4OLt.C()St: 7l,()t: .[J.l~(2
to Nearest. Loi: ]Line
ho Ab.sorp'hion
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 28 Block 6 Meadow Brook Subdivision-
Comments:
Af fadavit Attached
Disapproved:
Letter Attached: ( )
Date:
Date:
Department Worksheet:
dLJHLCIPAL, iTY OF ANCIIORA6L
O J'.{~/~<~-~ 825 ], SLrc:~ L, A~choraqe, A'[aska 995
7 R('quesk Eot App:ova] o~ llhldividual Sower and ~'-
,4.
Real kor,/Agenk:
Hailing Address:
Phone:
SJnqle Fnmi].y ,-' '' i ,, co f Bedrooms
Hu]tip].o Fanui. ty Rosider'~cc: ( ) Numbc;r off ]3edrooms .........
Nat. er Supply: *lnd:iv:idua]. Nei.I_ ( ) Public/Communihy Syshem (~
IL Indnvidua] W'] ].~ we] ] do}sLh
,,y, ......... namo of system · /:~
Sewage Disposal SysLem: *~On-sJte Syshem ( ) Public Syshem (~-~-
:llf On--.stke Syst:em, dh_tLc o. ins?all, aLien: ...............................
*NOTE:
A well ]ec! :ks required on AL!, we].ls drJ.]l, od since 6/75.
** If on--site sewe: s}she[n J.s over two{2) years old, an adequacy
~,st is -, · {~-,d bv th:is departmen~
A :ee of $25, O0 mush acoompauy each request befforo processing
cat] be Jlli L.i~i[:ocli.
3 /7 '7
