HomeMy WebLinkAboutLot 02, 03THIS PROJECT
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GREATER ANCHORAGE AREA BOROUGH
Dapartment of Environmental quality
3500 Tudor Road, AnohorSge, Alaska 99507 279-8686
Date Received
-'"
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Phone:
3. Legal Description: ~,~a
'
.... ...
5. Type of Facility to be Inspected:
Number of Bedrooms: ~ .....
Well Data:
C. Construction !l~}l '
Sewage Disposal System:
B. 'Depth~ ...........
D. Bacterial Analysis' __.
A. Installed B.
C. Septic Tank: 1. Size__ 2.
D. Seepage Ptt~ 1. Size 2.
E. Disposal Field: Total Length of Lines
Installer ..........
Manufacturer
Material
Distances:
A. Well To:
Septic Tank__
, Nearest Lot Line
Foundation to Septic Tank
Absorption Area to Nearest Lot Line
, Absorption Area ~, Sewer Lines
, Other Contamination_.__.
· ',, AbSorption Area
Request fur Approval of ~,~dividua] Sewer & Water Faotlit~
Page Two
9. Comments:
Approved
Disapproved Date
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of ~nvironmenta] quality
D%AGRAM OF SYST5~
I certify that the information contained in this request for appreval to be a true
and accura!~,e :enra:entation of the subiect sewer and water facilities located at:
Signed Date
J'im Rural,,:'11;
Sani ~a ri ~n
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