HomeMy WebLinkAboutTURPIN #1 BLK 3 LT 2
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Department of Environmental Quality x"" ~ ~'7~ .~??Tz~'''
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received .zTz~/~//~ /
GREATER ANCHORAGE AREA BOROUGH
Time of Inspection
1. Approval requested by:
Mailing Address:
2. Property Owner:
Date of InspeCtion
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOB
Phone: 3 3 7--/,07d
Phone:
Mailing Address:
3. Legal Description: /
4. Location:
6. Well Data:
A. Type ~ B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:~.
A. Installed ~.~ ~.. B. Installer ~ ~~-~x~(~i//~ ~'~/,..
, 2~-~ 2. Manufacturer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area ~ ~ 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank , Absorption area
Nearest lot line , Other contamination
B. Foundation to septic tank~o~
C. Absorption area to nearest lot line
, Absorption area
/
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
~ 'Pa§'e 2 of two pages - Re~_~st for Approval of Individual ~_.~er & Water Facilities
Legal Description
Approved
~ ~ Disapproved Date ~/~JJ
Approval~Valid for one year from date signed
Greater Anchorage Area 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)