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HomeMy WebLinkAboutBURLWOOD TERRACE BLK 3 LT 3oO7 C r.. ooo GREATER ANCHORAGE AREA BORf~3GH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 REQUEST FOR APmROVAL OF INDIVIDUAL SE%NER & '¢~ATER FACILITIES FOR 1. a~vroval Reques%~ ~y: Q "~ f /'~ 5. Ty~e of Facility to be Inspected: ~~~.. / Number of" Bedrooms: ~ ' A. Type 'L[ .z~r. B. Depth A. Installed 8. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: ].. Size 2. Material E Disposal Field: Total Length of Lines 9. Distances: A. Well To: Septic Tank__ , Absorption Area , Sewer Lines , Nearest Lot Line · Other Contamination B. Foundation to Seot~c T~nk ",, Ab~orotton Area · C. AbsorDtion Area to Nearest Lot Line · Rec~Je~t f~ Approval of l~.,ividua] Sewer & Water Facflitte~ Page Two l Ap~orova] Valid for One Year From Da%e Signed Greater Anchorage Area Borough, DeF~r%ment of Environ~ent~] Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representat~on of t. he subiect sewer and water facilities located Signed Date ~ (Fill out in T~ipl~,te) ,/ .... ." / ~" ~ 2. %~an,a of property own~ / ~ ~ 5. Water Analysis: a. Bacterial , C. Casin~ Size . ~,, 7 d. 'Distance from well to closest existing, or proposed: " 2. Septic tank . 3. Seepage Ar. ea . Cesspool' . , · 5. Propemty Line . J Sewage disposal system. a. Age of system . b. Septic tank capacity in gallons Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainag, e ditch, etc. · c. Name of septic tank manufactu~gr 1. If "home made" show diagram on reverse side of this form. d.' Disposal field or seepage pit size and type - 1. Distance to property llne to house foundation . Percolation. Test ~esults . f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagram should include the foilowinf information: p~operty lines~.well location, house location, ~eptic tank location, disposal area location, location of percolation test, and direction of ground slope. The information on this form. is true and correct to the best of my. knowledge. Signature of Applicant TO BE FILLED OUT BY HEALTH DEPARTr.IENT PERSONNEL ~e above described sanitary facilities are hereby approved, subject to The ~611owing con~'ions · " Conditions: _ _ . -- . ~~__ - /- , g - . The above described sanitary facilities are disapproved for the following reasons: lena ure o ~ ~1¢1 I , Approval is valid for one year following the date of approval. CPJ: cw GREATER ~C~ORAGE AREA BOROUGH HEALTH DEPARTHENT 327 Eagle Street Anchorage, Alaska 99501 Phone 272-6~67 June IS~ 1968 1700 Stmfoed An~hortgeo ~laska 9g$05 SUBJECTs Scrap DAopoeaX System brvAng $0#0 Lynn Way This notice is to ~emind you of the conditional approval of the subject system by this office. The conditional approval expires on July I0 IM8, Please contact this office to schedule final inspection of the required zaodificattons prior to backfilling. If we have not heard from you prior to the above expiration date, the system will autoemtically be disapproved. Sincerely, DAVID R. L-~ DUNOAN~ Medical Director I~aH/srr BY: Febnu~rv lq, ][~69 g!IBJ]~CT: Se;,,t',?_;",'e system serving 3925 6 3933 L./nn Avenne, ~tk: 2, Let IS', i1 f;urrlwood Sub. :eer "?r. :hitt;;~ker: :'4r. :qetz, t~e o~/ner, w[li :_,e r,~ ,:it ~ [ t'~ ~"~xcv:t. it' ::',~st~~ DN/bw