HomeMy WebLinkAboutLot 33, 34
Department of Environmental Quality
~,"X- ~ ~ "C" ,
~: ~u Street, Anchorage Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
· REQUEST FOR.APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
4.
5.
6.
Approval requested by:
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Location:
Type of facility to be inspected
Phone:
Well Data~ .
A. Type'"'~L.'":''i~ B. Depth
C. Construction ~ D. Bacterial Analysis
Sewag~e Disposal System: '/ ,!., . . ,,.
A. Installed _~F~¢~. ~ staller
~/ ~ ~ ~, -
C. Septic Tank: 1. Size 2. Manufacturer
No. of bedrooms
D. Seepage Pit: 1. Absorption Area
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
EQ-03~ (1/74) Page 1 of two pages
Page 2 of two pages
Legal Description
. Request for Approval of Individual S:wer & Water Facilities
Comments
Approved
Disapproved ~.~ ,~.~i,i '~)? ~i~! i, ~ate /'fl
Approval Valid for one year from date signed
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
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 Env~rcnmental Quality
3500 Tudor Road, Anchorage, Alaska
Date Received
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval Requested By:
Address: ,5-6 ;;?
Prooert¥ Owner:
a
Well Date:
C. Construcgion
B. DoD
D, Bacteria]
S)~)stem: /
Sewage Disoosal l.
C. Septic Tank: !, Size
[3. Installer
2. Manufacturer
D. Seepage Pit: 1. Size
2. Material
E. Disposal F~e].d: Tot. al Length of Lines
Distances:
Aa Well To: Septic Tank
, Neares% Lot line
B. Foundation to Septic Tank
, Absorption Area , Sewer Lines
· Other Contamination
% Ab§orption Area
C. Absorption Ares to Nearest Lot Line
Re,Nest for Approval of Im,.tvidual Sewar & ~/atar Facilities
~/~ ~p~ova] Va]id for One Year From Date Signed
Greater Anchorage Area 8orough, Department of ~nvi×'onmenta] Quality
D%AGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate represe~tatJon of the subject sower and water facilities located at:
Signed Date
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
T I M E:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED BY:
ADDRESS:
PHONE:
PROPERTY OWNER:
LEGAL DESCRIPTION:
TYPE FACILITY TO BE INSPECTED: ~/~z~'/~2¢~;/,~]STREET:
NUMBER OF BEDROOMS:
WELL DATA:
A.
B.
C.
D.
E.
YPE
DEPTH /~ '7/
SIZE
CONSTRUCTION
BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
A.
SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
1. SIZE
2. AGE
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A, WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D~ WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK
G, FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVED: DISAPPROVED:
DATE: DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALI'
GREATER ANCHORAGE
ENVIRONMENTAL
AREA BOROUGH
HOT-LINE
VIOLATION
LOCATION:
REFERRED TO: FIRE DEPT.
JUNK SECTION~
PUBLIC WORKS _ PLANNING DEPT.
AIR POLLUTION~_ SEWER & WATER ,~ ...
c/)' : <J
CALL BACKS: ....... I'":'--I--....
COMMENTS: