HomeMy WebLinkAboutLAKESIDE TERRACE LT 2
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
Approval'requested by:
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Location:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
3. 0~'%~' ~
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,
5. Type of facility to be inspected:::~ ::~:.:,. :7/. ,..',:.'...'
6.
Well Data:
A. Type
C. Construction
No. of bedrooms
Sewage Disposal System:
A. Installed
B. Depth
D. Bacterial Analysis
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
2. Manufacturer
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
E0-034 (1/74) Page 1 of two pages
Page. 2 of two pages - Request for Approval of Individual S~..er & Water Facilities
L e'ga 1 Description
Comments
Approved
Disapproved
Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I 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 ~~~ ~Z~~ Date ~