HomeMy WebLinkAboutSPRUCE ACRES LT 77
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by: ~/~.~z~ :~J~-~-i~
2. Property Owner: <~.~//e~ ~(57Z
Phone:
Mailing Address: :~r~ Q J
3. Legal Description: .~',:" ~m~
4.
Location:
5. Type of facility to be inspectS} r~e~ No. of bedrooms~~/~.
6. Well Data:
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: ~~---e~.~g~ /--
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8, Distances:
A. Well to: Septic tank , Absorption area , Sewer Lines ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Pa~< _'~f two pages -~o~-'st for Approval of Individu~ ?~-~r & Water Facilities
Legal Des~ription
Comments
Approved ~.~ Disapproved Date ~--/~-?~[
A~roval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ,034 (!/74)
06 1220(a Rev 1973
DAT~.
il ~A DEPARTMENT OF.~ItEALTN AND SOCIA~z~E. ;ES
Lab No
DIVISION OE~PUBLIC HEALTH
" IND V DUAl/AND SEMI-PUBLIC
BACTERIOLOG I CAL -WATER
/~_ ~: r'~ iL! '~ "-' - """ '~
~EMI-PUBLIC ~ ZHLO~INE RESIDUAL PPM'
REPORT RESULTS TO 7 ~ ~¢~
ZIP CODE=' I'
c' ,(:/c.~' '5 '
.COMPLETE THIS SECTION
. ON£Y'IF WATER IS AN INDIVIDUAL SUPPLY
READ INSTRUCTIONS
ON
ANALYSIS __ OEE,CR
[] Questionable
SANITARIAN'S REMARKS
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220 lb} B~CTERIOLOGICAL WATER ANALYSIS RECORD
~/7l~5k~-- am
FROM:
TO:
GREATER ANCHORAGE AREA BOROUGH
Dept, of Environmental Quality s T f P '
DEPARTMENT: UBJEC: A[~p]
BY: Susam, E._.D:Icker~o/~, DATE OF MEMO:
INITIATED
DATE ANSWER
DEPARTMENT: REQUESTED:
RECEIVER: ~a~
REQUESTED ACTION SCHEDULE
'FOR INFORMATION ONLY ~ :PREPARE BACK-UP INFORMATION
FOR MMED1ATE ACTION ~ CALL ME BEFORE YOU ANSWER
FOR YOUR CONSIDERATION ~ NEED YOUR RECOMMENDATION
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