HomeMy WebLinkAboutSPENARD HEIGHTS ADDITION LT 12GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT: // -~- ?/
TIME: ~'~ ~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED BY:
ADDRESS:
PHONE:
PROPERTY OWNER'
WELL DATA:
A. TYPE
B. DEPTH
LEGAL DESCRIPTION:
/,
BE INSPECTED:
TYPE
FACILITY
TO
NUMBER OF BEDROOMS:
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
· APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1 . SIZE
2, LINING
C, DISPOSAL FIELD
1, NUMBER OF LINES
2, TOTAL LENGTH
7, REQUIRED MEASUREMENTS
A, WELL TO SEPTIC TANK:'::'~"--¥ .,,.~:,~t:~:~ ..
B. WELL TO SEEPAGE PIT
C, WELL TO SEWER LINE
D, WELL TO PROPERTY LINE
E, WELL TO OTHER POSSIBLE CONTAMINATION
F FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT ~-.~ I
N. SEEPAGE PIT TO PROPERTY LINE
8, COMMENTS:
· .,~!
',,/_: -. .. ,
DATE: //~/0<~-7/ DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED,
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY