HomeMy WebLinkAboutJOHN O JONES LT 4
GREATER ANCHORAGE AREA BOROUGH~
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA
279-8686
99507
DATE RECEI )--? /
1
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
1. APPROVAL REQUESTED BY
ADDRESS'
P.ONE' ~- ~-~7~-0/
LEGAL DESCRIPTION ~,~F~-~//~/
TYPE FACILITY TO BE INSPECTED'
NUMBER OF BEDROOMS
WELL DATA·
A. TYPE
B. DEPTH /[/
C. SIZE
D.
E.
CONSTRUCTION L~,,
BACTERIAL ANALYSIS
STREET'//O~' U3d'
SEWAGE DISPOSAL SYSTEM
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
2. AGE
3. MANUFACTURER
4. INSTALLER
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
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
H. SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVED' DISAPPROVED
DATE' DATE'
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY