HomeMy WebLinkAboutBROWNS RESUB (PLAT P-472) LT 5 T13N R3W SEC 13
GREATER ANCHORAGE AREA BOROUGI'.
HEALTH DEPARTI~ENT
327 EAGLE STREET
ANCHORAOE, ALASKA 99501
279-2511
Approval Requested By
Address
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
FOR
.%6
Phone
~SPECT: ,~
TIME:_~ /67! O~)
2. Property O~ner Phone
Number of Bedrooms
5. Well Data:
Size
Ce
Construction
E. Bacterial
Sewage Disposal
Septic Tank (If homemade, show diagram on back)
3. Manufacturer
4. Installer
Approval Req~st £or Se
ge ~ Water Facilities
Seepage Pit
1. Si ze
2. Lining
C. Disposal Field
2. Total Length,
Required Measurements
A.
B.
C.
Number o£ Lines ~//~,, .,
Well to Septic Tank
Well to Seepage Pit
Well to Sewer Line
De
Well to Property Line ~d:) ,
Well to Other Possible Contamination
F. Foundation to Septic Tank
G. Foundation'to Seepage Pit~O
H. Seepage Pit to Property Line /5/
CO~ENTS:
APPROVED:
DATE:
APPROVAL VALID FOR ONE YEAR FRO[-.I DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTIt DEPARTMENT
EDll70
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Tripl~ ~ ..
'~%.. Name .of person requesting approval
2. ' ~ame of property: owner . ,
4. Number-el.bedrooms in house
5. Waten~,,Analy~ is:
a. Bacteri~Ll ~,
b. Detergent
Well data:
b. Depth
c. Casing Size
de
Distance from well to closest existing or proposed:
2. Septic tank
4. Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainaEe ditch, etc. .
7. Sewage disposal system.
a. Age of system .
b. Septic tank capacity in gallons ....
c. Name of septic tank manufactu~O.r .......
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepaFe pit size and type
1. Distance to property line /~ to house foundation
.e, Percolatiau T~st '~esults ...... ..
f. P~rcolation Test performed by
· ,~k~, Use the reverse ,side of this form to show diagram. Diagram should include
'.i.-%he foilowing information: p.ropePty lines; .well location, house location,
~Utlc tank location, disposal area location, location of percolation test,
and direction of ground slope.
9. The tnfox-ma~.ion on this form is true and correct to the best of my knowledge.
'of Applic~n't ' ~
TO BE FILLED OUT BY HEALTH DEPARTS.lENT PERSONNEL
~e above described sanitamy facilities are hereby approved, subje,~ct to~h_e
Conditions: ~, ~-~~ - - - "
The above described sanitary facilities are disapproved for the following
reasons:
Date
Approval is valid fo~ one year following the date of approval.
CPJ: cw
2,
3.
5.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
Name .of person requesting approval
h~ desc~iptio~ ~.4~..~ ~~,., 7
Number..of bedrooms in house
Watetx.,Analysis:
a. Bacte.Pial
b. DetePgent
Well data:
c. Casin~ Size
de
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank
3. Seepage Area~-O
Cesspool'
5. Property Line..,~0 .
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc, .
Sewage disposal system.
a. Age of system _ .~.. . .
b. Septic tank capacity in gallons
Name of septic tank manufactu2e,.r
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepaFe pit size and type
1. Distance to property line to house foundation .
Percolation T~st '~esults
f. Percolation Test performed by
Use the reverse,side of this form to show diagram.
"i'~he foJAowing information: ~operty lines;.wetl location, house location,
~tztic tank location, disposal area location, location of percolation test,
an~, direction of ground slope.
Diagram should include
9. The Infoz,mation on this form is true and correct to the best of my knowledge·
~:gna~tUre 'of' Appli6a~%
Date $i~ned
T_~O BE FILLED OUT BY HEALTH DEPAETr'.IENT PERSON,NEL
~fhe above described sanitary facilities are hereby approved, subjec~ to the
........... '~'llowing ' '
_ ........................
The above described sanitar~ f ' ' '
aczlztzes, are disapproved for the foilowing
reasons:
Approval is valid for one year following the date of approval.
CPJ: cw