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I~~ GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
Phone:
l~c,-,,. ,~.-E. ~ ~<~. 7a ,z.~.~,.-~-.~ Phone:
~o. of bedrooms
A. Type
C. Construction D. Bacterial Analysis
7. Sewage Disposal System.j~.~L_~
/
A. Installed B. Installer
C. Septic Tank: 1. Size y6-d/~. 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Se~ii:c 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-034 (1/74) Page 1 of two pages
Page 2 of two pages - Req~.t for ApprOval of Individual S.. ,' & Water Facilities
Legal Description
Comments
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
EQ-034 (1/74)
Date
IS'-'