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GREATER ANCHORAGB AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alssk~ 99507 279-8686
Date Received /,.d'7 -,~ 7~
Time of Inspection
Date of Inspection
RFQUEST FOR APPROVAL OF
INDIVIDUAl, SEWER & WATF. R FACILITIES
~ t FOR
3. Legal Descrip%5on:/~
,,
5. Type of Facility.to be Inspected:
Number of Bedrooms:
5.. Well Data:
Ye
Phone
A o Type ,%/%~ - ~',,~-/nC~/_z~- B. 'Depth_ ,
C. Construction~"~z~ ~?)t~,~L D. Bacterial Analysis'
Sewage Dfsoosal System:
A. Inst~lted 8. Ins%~ller
C. Septic Tank: 1, Size 2. Manufacturer ,.
D. Seepage Pit: 1. Size 2. Material. , · ... , ,
E. Disposal Field: Total Length of Lines , ,
Distances:
A. Well To: Septic Tank JOg I '
, Absorption Area~px I~o , Sewer Lines
, Nearest Lot Lfn~ /0/~ , Other Contamination
B. Foundation to Septic Tank ,~-$/I "~'Ab~orption Area ~/~
C. Absorption Area to Nearest Lot L~ne ·
R~quest for Approval o£k-~ndividual Sewer & Water ?aoilit~e~
Page Two
Comments:
Approved
Disapproved Date
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, DeFartment of Environmental Quality
DIAGRAM OF SYSTEM
3
I certify that the information contained in this request for approval to be a true
and accurate repro, sentation of the subject sewer and water facilities located at: