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