HomeMy WebLinkAboutSPERSTAD #2 BLK 5 LT 2
~ / : ~(_¥c/~:~ ~' ~/L~c~-~/ 3330 "C" Department ....GREATERS~._~) ~ /~~ ~-~ ANCHORAGE of "~ EnvironmentalAREA -~c4~)Z ~'%~ '~ BOROUGH ~ Quality ~ x/:'~-~-~)
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: P'~O~'~'.~-~'~ : ~~- <-~c~
Mailing
Address:
Phone: ~¢_ f~m~ F2F,:~.>
2. Property Owner: ~ ~::'~~
._~ _ . Phone:
3. Legal Description: · ~ . /~ ~ .~~ ~
J ,I ~,~ ~: /'~ /
5. Type of facility to be inspected No. of bedrooms
6.
Well Data:
A. Type ~/~_]~
B. Depth
C. Construction D. Bacterial Analysis
Sewage Disposal System: ~/q_~c~~
A. Installed /??~ /~ B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1174) Page 1 of two pages
Page 2 of two pages - Req '~ for Approval of Individual S ~ & Water Facilities
Legal Description
Comments
Approved Date
Greater Anchorage Area Borough, Department of Environmental Quality
Disapproved
Approval Valid for one year from date signed
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)
GREATER ANCHORAGE AREA BOROUGH.
Department of Environmental Quality
"C" St., Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
l, Type of Inspection:
2, Property Owner:
Mai-ling Address:
o
CMRO VA FHA
:f/f Phone
>~ ~X, ~/L}~ ~,a,y Phone
Mailing Address: -'~I'"~F' ~:~'V~c~.
Name of Lending Institution:
CONV
, A 77- F$~'~- -~--
Mailing Address:
Name of Realtor or Agent:
Mailing Address: ~)~D~
Phone
Legal Description:
Location:
g o
Type of Facility to be inspected:
No. Bdrms.
Water Supply
Type of Supply: Public Utility
Individual
If Individual, number of dwellings presently served
If Individual, depth of well CO
Sewage Disposal System
TMpe of Sys~em: Public U~]ity ln~iv~dua] (on-s~te)
If Individual, date of installation I ~ ~7 ~ O~ )~'~
EQ.-037 (1/74)