HomeMy WebLinkAboutBROOKWOOD BLK 4 LT 11-/72:
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHOIIAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY DEPT. OF H~-AL~'H &
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561ENVtIIONMENTAL pIIOTEC[IObl
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and VVATER FACILITIES R[c[IV[0
1. Type of Inspection: 0 CMRO VA FHA
Mailing Add re ss:~ ~ ~ .~ ~ ¢~ Day
CONV
Phone ~(.Z/~~'-',~'~/?'
3. Name of Buyer:
Mailing Address: Day Phone
4.Name of Lending Institution:
Mailing Address: Phone
5. Name of Realtor or Agen': /~/~t~>~:~z-~'~t ~)~~z~. ~,~~/~.~
Mailing Address: ~,~2~ C ,~_,~~ Phone ,~7~'~
7. Type of Facility; to be inspected:
8. Water Supply (qz~r-,¢,¢,~-~-~--~ ~'~T~-~
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
No. Bdrms. "<~'
Individual (on-site)
EQ-037 (I/74)
Page 2 of tw~o pages - Req ~t for Approval of Individual $
Water Facilities
Legal Description Lot 11 Block 4 Brookwood Subdivison
Comments
Approved
Disapprove¢~ Date ~~
Approval Valid for one year from
Greater Anchorage Ar~a 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 Date
EQ-034 (1/74)
172
al
HUFFM/~N
163
171 ~))>- 173
178
Rabbit Creek Area Reference Map-P13
1974 JH
4.1
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK: Distance f~o. well~.~.Mate~ial ,, ,,~., Number of compartments _
Liquid capacity I~O gallons. Inside length ~"Inside._ _ width ~_ ,..Liquid depth
SEEPAGE SYSTEM: Seepage Pit: Nu~eP of pits~utside dia~e~ ._~. _._
width -._ , length... ...,, depth : ~, lining ~e~al.. ...... . Dist~ce
well ........ , building lo.clarion :: ._ _, nearest lot l~ne. _. To~al effective
~somption a~ea (wall a~a) sq. ft.
TILE DRAIN FIELD: Distance fPom well~, fo~dation ~ , nearest lot line
lotal length of lzu~ Nu~e~ of lines ~ Distance between lines ,~ T~nch
wxd~ n. To~al effec~t~ absorption a~ea~sg, f~. LenEth of each line
Depth: Top of tile ~o finish Emade ~ Depth of filteP ~e~ial beneath
tile_~_ l~' in. Above tile_
WELL: Type , depth , dist~ce ~om building fo~datiou .... . hearst
lot liue~, nearest sewe~ line_ , septic tank .... , seepage system. :
cesspo~],~_ . ~ othep souPces
DIAG~M OF SYSTEM
DISTANCES:
DATE:
APPROVED
"Health' Au.'~h-Oz'ity ...........