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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 1 LT 3Crnimo lo" GRE, 'ER ANCHORAGE AREA EOF' iJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS~O~' ~-1__~ ~ ~,E LEGAL DFSCRIPTION / PHONE SEPTIC TANK: DISTANCE FROM WELL /(/~ MANUFACTURER INSIDE LENGTH_____ INSIDE WIDTH ~ ~. ~--.~./ NUMBER OF MATERIAL ~ COMPARTMENTS __LIQUID DEPTH __.LIQUID CAPACITY /g~g')¢2 . GALLONS. NUMBER OF PITS ~1 DIAMETER OR WIDTH LENG7H DEPTH ~ LINING MA TERIA¢~ ¢*& CRIB SIZE: DIAMETER~DEPT" ¢ f . _ . _ DISTANCE FROM: WELL BUILDING FOUNDATION~¢~-, NEAREST LOT LINE~ ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) *~. SQ. FT. ADDITIONAL ABSORPTION / WELL: TY P E,~./1/¢ ~ ~/ CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE TANK __ CESSPOOL _ , OTHER SOURCES APPROVED_____ DISAPPROVED __ REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY:,..(~/ ' PIPE MATERIAL: LOT SI_OPE: REMARKS: Form No, EO-O31 DIAGRAM OF' SYSTEM DEPARTMENT OF ENVIRONMENTAL QUALITY "EGA" O ESOR'PT'O" £ ? / , TANK . ~ SEEPAGE PIT . ~AIN ~B~ TYP~ AND SIZE OF FACILITY TO BE SERVED __~ FINANCED THROUGH SOIL TEST RESULTS PHONE OTHER, THIS pERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BA(.'KFILLING OF- A~NY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BIZ SUBJECT TO PROSECUTION· ~EPTIC TANK TO SEEPAGE PIT WALL TO NEAREST LOT LINE. DRAIN fielD- ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK //'~ ! SEEPAGE PIT DRAIN FIELD ~ ? ~ ~ TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB GROSSING GAP OF EXCAVATION D FEET INTO UNDISTURBED SOIL, 4 INCH'DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT fITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR [ CERTIFY THAT I AM F~'MILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA DESCRIB D SYSTEM [5 IN ACCORDANCE WITH SAID NANCE NO. 28-08 AND THAT THE ABOVE 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 007-279-2581 July 29, 1975 WO #17740 Mr. Brig Morgan Box 268-E Star Route A Anchorage, AK 99507 Subject: Percolation Study, Lot 3C, Block 1 Skyway Park Estates Dear Mr. Morgan: Transmitted herein is our analysis of the existing soil conditions as observed in a test pit dug at the approximate location of the planned seepage pit on the above referenced 10t. The pit was actually located 50' west and 50' south of the NE corner of the loto You will find the following enclosed in this report: Test Hole Log Sheet 1 Standard Explanatory Information Sheets 2-4 The soil profile, as exposed by the test pit, was logged on July 24, 1975 by Mr. O. M. Hatch, senior technician of our staff. The soils encountered in the test pit were frost susceptible silts, sandy silts and gravelly sands. The first 3-1/2 feet was a brown sandy silt. From 3-1/2 to 11-1/2 feet was a brown silty sand with a silt content ranging from 30% to 10% by volume and decreasing with depth. Below 11--1/2 feet a brown gravelly sand was encountered. The free water level was observed as being at 13-1/2' below the ground surface. Please note that the regulations of the Greater Anchorage Area Borough require that the bottom of t~he septic tank be at least 4' above the free water level. The Greater Anchorage Area Borough has established the amount of seepage area per bedroom needed based 9n the unified classification of the soil. From our visual classi- fication of the existing site soils and using the Borough design criteria, the seepage area required should be no more than 250 square feet per bedroom. Mr. Brig Morgan July 29, 1975 Page 2 The unified soil classification of each soil type encountered and the free water level observed at the time of exploration is contained on the test hole log to aid in proportioning a specific seepage pit if so required. Enclosed are some excerpts from the State and Borough Ordinances which may be of value to you. For further restrictions, particularly with reference to location of the seepage pit, we call your attention to the Greater Anchorage Area Borough Ordinance 28-68. If we may of further service to you in this regard, please contact our office. Very truly yours, ALASKA TESTLAB Laboratory Supervisor MRN:rb Enclosures Test Hole #1 Table A WO ~17440 Depth in Feet From To 0.0' 3.5 3.5' 11.5 11.5' 16.0 Soil Description F-4, brown Sand_y_ Silt, ML, damp, stiff. F--2, brown piltz Sand, SM, with a variable amount of silt (10%-30% by volume) damp, medium density. NFS/F-2, brown ~r__avell~ Sand, SP, wet to saturated, medium density, rounded particles with maximum size being 3". Bottom of Test Hole: Frost Line: Free Water Level: Remarks: 16.0' None Observed 13.5' The recorded free water level is for the date of exploration. Seasonal and climate variance of this value should be expected. sa_sILPlq P~P~I 1 3.0'-11.5' Type of Dry Blows/6" M% ~ample Strength Grou~ Unified .... Gr&b .... SM 4040 "B" STREET, ANCHORAGE, ALASKA 29503 PHONE: ~?07-277-2581 August 1, 1975 W.O. 17740 Mr. Brig Morgan Box 268-E Star Route A Anchorage, AK 99507 Re: Soils Test, Lot 3C~ Blk. 1 Skyway Park Estates Dear Mr. Morgan: Please note that the percolation rating for the soils listed at depth 3.5' to 1]..5' in our report dated July 29, 1975 for the above referenced project should be rated 225 square feet per bedroom instead of 250 square feet per bedroom listed. It is our opinion the soil should percolate sufficiently for a seepage pit usage. Your very truly, Alaska Testlab Melvz~n Il. Nichols, c.E. Laboratory Supervisor MRN: pf cc: Rolf Stricklund, DEQ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) /~ / ~' ~/~.r~ ~.~ ~T (b) Applicant Name ~'zM~ ~?, Telephone: Home ~'~Z Applicant Address . ~]~r) ,~ ~'~t~'~ ~(-~/~ (c) Applicant is (check one): Le~ding Institution ~; Owner/builder ~; Buyer ~; Other ~' (explain); (d) 'Lending Institution ~ Telephone Address (e) Real Estate Company and Agent ~7~¢ ,/~F/~" ~ Address ~¢~ ~ Telephone ~ ~'- 7~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single~Family/~' Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community r'] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hea'l'th Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, Address ,207 ~ . Telephone -~ 7(~-' ;5 ,;~ j ~ DHEP APPROVAIJ Approved for '7'('~'~'¢"~¢'~)-bedrooms by "'~-'~--"~ ''~' Approved Disapproved Conditional Terms of conditional Approyal Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based aolely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer'a work. Page 2 of 2 72-025 (11/84) ^NCHOR,~NIClPALITY~,,~,. OF ANCHORAGE (MOA) MUNICIPALHY OF DEPL OF I4EALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROfECTION CHECKLIST- FEBRUARY 1984 2644720 I. E0 1986 Legal DescriPtion: ~-, o 7~ RECEIVED WELL DATA Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Well Classificatio:'~"~/v,4Tm~ If A, B, C, D.E.C. Approved (Y/N} ~/ Well Log Present (Y/N) _/~ ¢ Date Completed /~0,~.4~/,-( (¢~ ~ Yield Total Depth ~0 / ~ Cased to ~O' ~ De~th of G~outing _ ~o~ C -~. StatioWaterLevel ~r¢~c~ (~¢FI3/~) ~ PumpSetAt Casing Height Above Ground ~-7 ~ (~ Sanitary Seal on Casing (Y/N) Y Y Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot /~ z ~ ; On Adjoining Lots /~O To Nearest Edge of Absorption Field on Lot /~ / ~ ; On Adjoining Lots /~0 To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole _ ~ To Nearest Sewer Service Line on Lot Water Sample Collected by '--~ ~ ; Date ~/~ Water Sample Test Results ~ T/~ F~ Comments ~ ~l~{~ ~eY-~$t~r~(~Z,~ ~y SEPTIC/HOLDING TANK DATA gd ¢m~¢ /¢~, Date Installed /o/ge/g4~ Size /0~ No. of Compartments Standpipes (Y/N) ~ ~ Air4ight Caps (Y/N) ~ Foundation Cleanout (Y/N) _ Depression over Tank fi/N) . ~ Date Last PumPed gqz~[ Pumping/Maintenance Contract on File (Y/N) ~/~ ; for Holding Tank High-Water Alarm fi/N) _~[~ _ Temporary Holding Tank Permit (Y/N) _~ Separation Distances from Septic/Holding Tank: To Water-Supply Well ~) ~7 / © To Building Foundation g~ To Property Line ~0 t~ To Disposal Field g~O ~ ~ To Water Main/Service Line ~ To Stream, Pond, kake, or Major Drainage Course . Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /0/~[S'/'75 ~ Width of Field .'~4 '~r.o ~' Square Feet of Absorption Area Type of System Design Length of Field Depth of Field (.a / © Gravel Bed Thickness bJ/~ Standpipes Present (Y/N) Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'?(-~' / To Building Foundation 4-~ / Lot /~../O 2V'~" To Water Main/Service Line A,// To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments (~ /2~'~, /)-bf-/~,/4 Date of Last Adequacy Test To Property Line .~"O__ To Existing or Abandoned System on ; On Adjoining Lots [~O 2 (~ To Cutbank (if present) D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level a Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~J~7~/'~/~/ ,5¢~/¢4,'/'. / Date /~/~[ ~ Company ~)~-~~MOANo. '~//~ ReceiptNo. Zm~/ ~ /~ Date of Payment /~/~/~ Page 2 of 2 72-026 (11/84) · DAI E RECEIVED INSPECTION APPOINTMENTS TIME TIME , TIM DATE DATE MUNICIPALITY OF ANCHORAGE ENVIEONMENIAI ....  DEPARTMENT DF HEALTH & ENVlRON~ENI'AL PROTECTION ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts o1~ page 1, Incomplete requests will IlOt be processed, Please allow tell (10) days for processilig, ~ ~ PHONE MAILING ADDRESS PROPERTY RES DENT (If different from above) PHONE ~ BUYBR PHONE MAILING ADDRESS ~AI LING ADDRESS ~ REAL.TOR/AGENT~ ~/~F /~J'~ /~"~ " .. PHONE ~AILINGADDRES~ ~ ~~/ ~r ~ ~ '~. LEGAL DESCRIPTION - If'/7/- - 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [~' SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six [] Otnm 7, WATFR SUPPLY ~], INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wel s drilled [] COMMUNITY since June '1975. For wells drilled odor to that oa[e, give wel [] Pt~BLIC UTI LI-FY depth (attach log [ available S, SEWAGE DISPOSAL SYSTEM [~' iNDiViDUAL/ON.SiTE,~ / ¢'.2 )'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] [NDIVI DUAL DEPTH OF WELL BI COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY J'O --~'~-D,~' ._ 'W-~O.4z.-C,~ ~ Connection Verified INSTALLER ~SepticTanko[ ~HoldingTank, ,_r~ Size: f~- ~" If Tank is homemade SOILS RATING give dimensions: ~.~ ~;¢~,;;: 4. DISTANCES Septic/Holding Tank Absorption Area er Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~ CONDITIONAL APPROVAL (letter = ~t accompany certificate) ' '~D[SAPPROVED .~J 72-010 (Rev. 6/79) Tobben Spur land P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 May 15, 1981 MUNICIPAI. ITY OF ANCHORAGE DEPT, OF IIEALiH & J~NVIRONMENrAL Iq C[ECTIC)N ivtAY J. 9 1981 RECEIVED Anshorage ~and & Gravel 1813 E 1st Ave Aneho:r~ge, Ak. 99501 Attn: Credit Depto Legal · o .lle.. Buyer: Lot 30~ Block 1, ~kyway Park ]~state Herb Long Tunnell Refer to Inspeetiolt and test report dated J~nuary 12, 3.9~1 by 'JTobben Spurkland P.E. This system wo.s forested on May 14 & 15th ~o ' 19ol. On May 13th tho tank was pumped and on the 14th water was added to the crib in ~00 gals incre];'~ents. The following measurements were taken. Water Volume Liquid Depth (g~.o) (inches) O 5OO 1 ~000 1,400 On May 15th Test Resu~Lt ~ 48 50 500 gal. the ~Liquid~.evel in ~he crib rose 2 inches~ For The liquid level dropped 2'~inches in 24 hours,, Absorption rate is 500 gal./24 hr. The municip~al code requires absorption rato of 150 g~. pot bedroom. This system sufficient for a 3 bedroom honse. Tobben Spurkland P.E. 8155 Cranberry St, Anchorage, Alaska 99502 Phone (907) 243-5302 Bob Hunter Marston Real Estate 2804 Northern Lights Blvdo Anchorage,Alaska 99503 1981 DEPT. OE i'. Ii [ & ENVIRONMEN1AI. ;, c~ !CTION · AFl 1 'i,'}8'i R/ CEIVED SEWER ADE~AG Y TEST Legal: Lecat ion: Owner: Residenco: Wat e r: Sewer; Lot 3~ Block 1, Skyway Park Estate On Klatt Road Herb Long Three bedrooms, not occupied since August 1980. On site well From Municipal Records: Tank: 1000 gal., Steel, Steer Absorption: Two leg cribs, 8x8x6 Absorption Area: 732 sq. ft. Soil Rating: 250 Date of Test: Jan.6-- Jan 10, 1!)81 Test J~'rocedure: System was inspected on Dec. 16, 1980. Tank was found frozen, no signs of cribs or vents. Tank was thawed ahd pumped on Dec. 22. Ground thawed and one crib vent exposed on Jan~ 4, 1981. Bottom of crib 10 feet below ground level. No liquid or ice in crib. Vent extended to two feet above ground ilevel. On Jan. 6 1981, 3000 gal. of water was introduced into crib and the following readings of the liquid depth taken: Start Test Jan 6, 1981. O inches Add 1500 galo 17 inches ~d 1500 gal. 32 inches Check Jan. 7 Check Jan. 8 32 inches 32 inches On Jan. 9 an additional 2000 gal was d~lped into the crib. The liquid depth rose to 38~ inches. On Jan. 10 the depth was 37~ inches. Test H~s~.t: Inconclusive. Tobben Spurkland P.E, Bob Hunter t~ge 2 Jan. 12, 1981 Discussion~ Conclusion: Th:is system was instal.led in 1975. According to Les Buchholz, screened rock, ~-inch minus was used for backfill. The residence has been vacant since ~ugust 1980. We have had an unusual cold December with no snsw cover. Test holes dug by Anchorage Water and Sewer Utility show the freeze front at eight feet plus. I suspect that the ground around 'this system is frozen and that no absorption is taking place because of that. The facts that the pit was dry when first inspected and that 5oeo gal. of water was absorbed by the rock backfill make me believe that the system operated properly prior to freeze up and that it will continue to operate properly when put into use again,, The heat from the waste water should thaw 'the ground and start the absorption. It is my professional opinion that this system does not operate presently due to tho cold weather in December. %&eh the soil around the pit is thawed the system will perform to the required standards. Anchorage Sand & Gravel 1813 E 1st ave ;~nchorage, Ak. 99501 Attn: Credit Dept. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Hay 15, 1981 MUNICIPALITY OF ANCHORAGE DEPT. OF HEAL]kt & ENVIRONMENT',L i, JU,' 5 I981 RECEIVED SE%,~R AD2%UACY TLUT Legal: Seller: Buyer: Lot 3C, Block 1, Skyway Park Estate Herb Long Tunnell Refer to Inspection and test report dated January 12, 1981 by Tobben Spurkland P.E. This system was retested on [.iay 14 g- 15th 1981. On l[ay 13th the tank was ptm]ped and on the 14th water was added to the crib in 500 gal. increments. The following measurements were taken. Water Volume Liquid Depth (ga!.) (inches) ~est 0 1,000 1,400 May 15th Result: 52 For each 500 gCLlo the liquid~evel in the crib rose 2 inchec,. The l=.cuzd level droppe~ 2 zneb. es :in 24 hours, nbsorption rate is 500 g~ul./24 hr. The municipol code require~ an absorption rate of 150 gal. per bedroom. This system is sufficient for a 3 bedroom house. Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received October 6, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Thurs. Cony. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: United Bank Alaska 645 G Street Phone: Brig Morgan Builders Phone: Box 268E Star Route A 278-9526 344-1327 3. Legal Description: Lot 3C Blockt Skyway Park Estates 4. Location: 5. Type of facility to be inspected 6. Well Data: A, Type Individual C. Construction Sewage Disposal A. Installed C. Septic Tank: D. Seepage Pit: Single Family No. of bedrooms System: 1975 1. Size 1. B. Depth 60' D. Bacterial Analysis On-site system B. Installer 2. Manufacturer Absorption Area 2. Material E. Disposal Field: Total Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank length of lines __ , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~ st for Approval of Individual F ~r & Water Facilities Legal Descri]tion Lot 3C Block Skyway Park Estates Comments Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Date .~C., 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 (1/74) jO MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION ~' 2510 East l'udor Road, Anchorage, Alaska 99504 276-2221 ':' '~/' ,,~ REQUEST FOR APPROVAL OF \~/'\b;~ INDIVIDUAL SEWER and WATER FACILITIES 1, Type of Inspection: CM RO VA FHA CONY. Mailing Address: 4. Name of Lending Institution: Day Phone: Mailing Address: Phone:_ 5. Name of Realtor or Agent:_ Mailing Address: Phone: 6. Legal Description' I(~' !3~-.~ ~ll~,._ ?-~-~£.~;'(~(~L./\ ~g-R.l/~.. ~_~,, 7. Type of Facility to be Inspected: ~ ~ ~ No, Bdrms. Water SuppLy Type of Supply: ~[ / Public Utility If Individual, number of dwellings presently served If Individual, depth of well. (.,~ C-) -~'[ · Individual Sewage Disposal System Type of System: Public Utility If Individual, date of installation ~J~(~'~ b ~/ Individual (on-site)_.~~'' 72-003(3/76)