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HomeMy WebLinkAboutBETTYS LT 5-06 © GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Da~e Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested Mailing Address: Phone: 2. Property Owner: Phone: Mailing Address: 3. Legal Description: /J~ /~Y~ / ~~ "~//-.~ 4. Location: ~q/TlC //~ /~_~ )y ~y '5. Type of facility to be inspected ~t~ No. of bedrooms 6. Well Data: , A. Type ~ ~/~'~-~ ~ B. ~. ~) , Depth. C. Construction f~ Y ~.?z~-~-~D. Bact,erlal Analys~/ 7. Sewage Disposal System: ~/~ ~ A. Installed , B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: ~- 1. Absorption Area 2. Material Be E. D~sposal Field: Distances: A. Well to: Septic tank Nearest lot l~ne Total length of lines , Absorption area , Other rcontam~nat~on Sewer Lines , B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH.. Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 1. ~TYi~e nf In~pect~; 2. Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES CM~O ~ VA ~~FHA CON~ 3. Name of Buyer: Mailing Address: Day Phone 4. Name of Lending Institution: Mailing Address: Phone 5. Name of Realtor or Agent: Ma~ling Address: Phone Typ~ of Facility to be inspected: Water Supply Type of Supply: Public Utility ...... If-Individual, number of dwellings Ind~v~ presently No. Bdrms. served If Individual, depth of well 9. Sewage D3sposal System Type of System: Publ3c Utlllty Ind~v3dual (on-site) If Individual, date of installation ~ EQ-037 (3/74) ~Pa~e 2 of two pages - Re"'~st for Approval of Individual rM'~er & Water Facilities Legal Description Comments Approved Disapproved Date Approval~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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 (1/74)