HomeMy WebLinkAboutSOUTHWOOD PARK BLK 4 LT 2Olgt- o7a-- afl'
GREATER A~CHORAGE AREA BOROUG}N.~,
HEALTH DEPARTI~IENT .'~
Approval Requested By
Addres,s ~- ~-~tS~ ?
$27 EAGLE STREET
ANCflORAGE~ ALASKA 99501
279-2Sll
REQUEST FOR APPROVAL OF
INDIVIDUAL SE~AGE ~aND ~VATER FACILITIES
FOR
~pe of Facility to be Insp~e~e ~7~
N~be~ o~ Bedroo~
5. ~ell Data:
A. Type
C, Size
D. Construction
E. Bacterial Analysis
Sewage Disposal System:
A. Septic Tank (If homemade, show diagram on back)
3. Manufacturer X~
4. Installer
Approval Request for Se~e ~ Water Facilities
Page T~o
B. Seepage Pit
1. Size
2. Lining
C. Disposal Field
1. Number o£ Lines
2. Total Length
Required Measurements
A. Well to Septic Tank
B.
C.
D.
E.
F.
G.
H.
Well to Seepage Fit
Well to Sewer Line
~ell to Property Line /~f/~ ,, .
Nell to Other Possible Contamination
Foundation to Septic Tank
Foundation to Seepage Pit.2f~7~
Seepage Pit to Property Line
8. COIV~ENTS:
DISAPPROVED:
DATE: DATE:
APPROVAL VALID FOR ONE YEAR FRObl DATE SIGheD.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT
EDll70: