HomeMy WebLinkAboutJOHN O JONES LT 3010 34-
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
330 "¢" Street, Anchorage, Alaska 99503 274-4561
4.
5.
6.
Date Received
Time of Inspection C'~
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by~.~ ~-~c~d
Ma~llng Address' (~q~ ~
Property Owner· c-~t, 0,~
Mailing Address: IIL]]~
Legal Description: ~xz~
Location ~\E'/~l I~ '~e~' ~-~/nq'-~ ~::~.~-~ ,~-
Type of facility to be Inspected Jx~ ~l~l~ ~o~r~ ~,~
Well Data: ~
A. Type ~,~f~,~t~ B. Depth
Phone'
Phone
No. of bedrooms
e
C. Construction D. Bacterial Analysis
Sewage Disposal System.
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
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274 4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1 Type of Inspection CMRO VA
2 Property Owner '/~t~'~
Ma,hng Address
3 Name of Buyer -~~
FHA CONV
Day Phone 'dC 2-"~'~:¢'.,~~'
Mmhng Address Day Phone
4 Nameof Lend,nglnst,tut,on ~ ,~r~'
Ma,hngAddress ~ ~ ~L ~ ~ Phone
5 Name of Realtor or Agent
Madlng Address [~
6 LegalDescr,pt,on /~ ~
7 Type of Facility to be ~nspected
8 Water Supply
Type of Supply
No Bdrms
Public Utd~ty ~
If Individual, number of dwelhngs presently served
If Indlwdual, depth of well
Sewage D~sposal System
Type of System
Ind~wdual
/
Pubhc Utd~ty X
Ind~wdual (on-rote)
If Individual, date of ~nstallat~on
EQ 037 (1/74)
Page 2 of.two pages - Ret..~st for Approval of Individual S...~-~r & Water Facilities
Legal Description ~[~C~ ~ ~m~% ~) ~LFJ ~, ~±~,OYV~
Approva~/alld for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the ~nformatlon contained ~n th~s 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) ,