HomeMy WebLinkAboutBURLWOOD TERRACE Block 2 Lot 13
GREATER ANCHORAGE AREA BOROUGE
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
279-2511
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
FOR
1. Approval Requested By .,.
2. Property Owner (~. ~C/". :~y~_~,~/-- ~~( Phone
Number of Bedrooms
S. Well Data:
A. Type
B. Depth
C. Size
D. Cons truction
E. Bacterial Analysis
6. Sewage Disposal System:
A. Septic Tank (If homemade,
1. Size
2. Age
3. Manufacturer
show diagram on back) _~
-?/.
4. Installer
Approval Request £or Se
Page T~o
Water Facilities
B.
C.
D.
E.
F.
G.
H.
B. Seepage Pit
1. Size
2. Lining
C. Disposal Field
1. Number o£ Lines
2. Total Length
Required Measurements
Well to Septic Tank
Well to Seepage Pit
Well to Sewer Line
Well to Property Line
Well to Other Possible Contamination
Foundation to Septic Tank
Foundation to Seepage Pit
Seepage Pit to Property Line
COF94ENTS:
APPROVED: ,~
DATE:~ DATE:
APPROVAL VALID FOR ONE YEAR FRO~I DATE SIGNED.
DISAPPROVED:
GREATER ANCHORAGE AREA BOROUGH HEAL~-t DEPARI~ENT
EDl170