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Home My WebLink AboutCAMPBELL POINT BLK 2 LT 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _ O i I - ~.J~'~,_ - I 1, GENERAL INFORMATION Complete legal description Location (site address or directions) (~ i.~ :~_.c~ I Jr (~L~_.L~,,- ~ ,' v-~. I~ Property owner Mailing address _ Lending agency. Mailin. g address Agent Address Day I~.hone n~%.. Day phone. Day phone ~'~6 Unless otherwise requested, HAA will be held for pickup.. NUMBER OF BEDROOMS: ..~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank--=- Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my · investigation of this Health Authority Approval application 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. NameofFirm T~'~J~¢~ Phone ~2-'J~'~ll~ Address ~'~ ~ I.~ ! ~/.~41 ~W ~ ~ Engineers signature ~ ~_~~ Date q~G/~ ~ DHHS SIGNATURE J A.p.p roved fo r '"~ ~--,[-~ Disapproved. Conditional approval for bedrooms. '. bedrooms, with tee following stipulations: Additional comments By: The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes, and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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's work. X : _t-IVED MuniciPality of Anchorage :~[P 2 8 ~ En~mnme~l Se~s D~ion ~~ ~~ 8~ L ~et, R~m 502 * Anchorage, Nas~ 99501 · (~ ~7~ Health Authority Approval Checklist LegaJDescripttun: /ol~,~V,~.; ~--o~,o~r~,c// PoivF~'parcell. D.: I WELL DATA Weft type i~t,,~. ~1 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth ' ' Cased to Date of test FROM WELL LOG g.p.m. Casing height (above ground) Wlre~ properly protected (Y/N) AT INSPECTION Stelie water level Well production WATER SAMPLE RESULTS: g.p.m. Coliform ~'~' ~ Nib'ate. B. SEPTIC/HOLDING TANK DATA Foundation deanout (Y/N) Depre.~don (Y/N). t*,,,~. Pumper IA c~eanou~ (Y/N). High water alaml (Y/N), [~- ~ C. ABSORFrlON REID DATA Date i.~ ~ ~/(~/~ '-n~ N. F-,, w~ Soil rating (g.p.d.//t' or ~/bdrm) ~;'~'-/~?-J-System type~ N,t'~ Gravel thlckne~s below pipe ~l.I ToteJdepth /5 ' ~'A/~ Effecltve absorpllon ama ~ Monifodng Tube pm,~nt (Y/N)._~_ Dapmsslon over field (Y/N).. Date of adequacy test ~ Resutte (pass/FalO '~ For -'~ bedrooms Flutddepthinabs°rPtionlleldbef°mtest(In');?'t'~: ~;~K-Immedlatelyafter-/',2OgaLwateradded (In.): .~ II Ftuiddeplh ~ pm)Minutes latec ~ Abeorp~onr~e ,, ~ Zj/,5,-D oP.d. Peroxide lmalment (past 12 months) (Y/N) ~ - ~-- If yes, give date. D. UFT STATION N//~ Date installed Manhole/Access (Y/N) High water Marm level at* Size in gallons. "Pump on" level st' *Datum "Pump orr level at' Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SeptiC/holding tank on lot Absoq~ion field on lot I iD Public sewer main N/,& Sewer/septic sewice line On adjacent lots On adjacent lots public sewer manhole/cleanout Li~ station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ _~ I Property line ' ~ C) , Abso~tion field Water main/sewice line ,~/') Surface water/drainage td/r~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ Building foundation Wells on adjacent lots {ID Water main/sewine line Surface wa~er /~ o, ~_ Driveway, pa~dng/vehlcle Cu~aln drain /~ ~ ~4 ~. Wells on ad]asent lots F. ENGINEER'S CERTIFICATION ~,., ,..,.,,,~rmance with MOA HAA guidellnes in effect on thls date' ....... ~' ~1 1. <:2 .,..., ~., Waiver Fee $ D~te o~ P~mem Receipt Number 72-026 (Rev. am6)' T.S~URKLAND P.E. 203 W. 15lb. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RECEIVED SEP 28 1998 /~lUtliC~pall[). wl Atic~oragG Oept. Health & Human Services Municipality of Anchorage Deparlment of tlealth and Social Services 820 1 SU'eet Anchorage, Alaska 99501 September 26, 1998 Subject: ttAA Lot 2 Block 2 Campbell Point J.G. Manson Gentlemen; We are applying for aa tIAA for this property. The ownership is being transferred and according to AMC Sections 15.55 and 15.65 an tIAA is requlred. The present residence was constructed in 1978, however, a mobile home trailer occupied the lot prior to that year. A trailer was also located on lot 1. The septic system was installed in the late 1960's. No records have been found regarding the septic system. The original well was abandoned in 1971 when a well was drilled on lot 3. This well served lots 1,2, and 3. The present well was approved by ADEC in 1996. In 1995 the septic systems on lot 2 and lot 3 were investigated and tested. From statements made by the owner, and by soundings is was determined that the septic system on lot 2 consist of an Espinosa Concrete tank and a concrete pit. Both the septic tank and the crib have 7 feet of cover. Excavating the tank and the crib to verify would result in destroying most of the pavement and cause major disturbance to the front yard. There are no indications that either the tank or the crib are in any kind ofdistress. At the present time the residence has been vacant for an extended period of time. The crib was dry when inspected on September 2 I. Loading the crib with 2000 gallons of water over a 6.5 hour period caused a short term accumulation of water in the crib. On September 23 another 630 gallons of water was added to the crib, this water disappeared within 30 minutes. The test in 1995 is enclosed for your review. There are soilslogs on file at DHSS from Lot 3. The locations ofthe pits are within 30 feet of the crib on Lot 2, and sh°uld therefore meet the code requirement regarding soil conditions. The amount ofabsorption area can not be found without excavating the system, however, the fact that the system was working properly in 1995, when the system was in continuous use, and appears to be working to day, after not being used for a year, negates the need for determining the absorption area. Yours C'f&£ ReL# Client Name Projec! Name/# Client Sample ID Matt~ 982386021 '1 ob~en Spurl0and p.£. 2/2 Campbell Pt. Drinking Water Client POt/ Printed Date/Time 09/25/98 14:03 Collected Date/Time 09121198 15:18 Received Date/Time 09/21/98 16;00 Te~nica/Director: Stephen C. Erie 000000 Released By Sample Remarks: ~ Released By ~ _ . ~ttc~eb~e Prep A~elysls ?rt~etcr k?utts ~o: ~ Units ?thud _ ~,lmits _ ~,ate D_ate /nit ~iteate-~ 0 cot/100~L $~18 0.1C0 u 0.100 It, lL EPA ~00.0 10 ~x 09121/98 0~121198 :~e'"]~"~'''~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION · SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 3 $ O- SLOPE SITE PLAN lO 13-' 15 16 17- 19 2O COMMENTS WASGROUNDWATER ENCOUNTERED? ~,.~0 E IF Y ;~. ATWHAT L A. KINCAID 4376E PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT F:.~/--~6-1u.F. IOT LL~IJE. L ~ -- c) FT. PERFORMED D DEiTy OF EN'.¥11iONMENTAIo CONSEII%~%TION ANCHORAGENVESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 January 26,1996 TONY KNOWLE$o GOVERNOR (907) 269-7505 Mr. Tobben Spurkland 203 West 15th Ave., Suite 203 Anchorage, AK 99501 SUBJECT: Lots 2 & 3, Block 2 Campbell Point Subdivision - 8439 Heather Circle; Operation Approval Class "C" Public Water System, ADEC Project No. 9621-DW-339-099 and 9621-WV-339-027 Dear Mr. Spurkland: This letter is in response to the i~formation received in this office December 5, 1995, requesting operation approval of the Class "C" public water system serving the above- referenced lots. The Department has completed its review of the submitted information which included a completed class "C" public water system checklist, well flow test, as- built site plans, well log, recent water sample analyses for total coliform bacteria and inorganics for nitrate, and surrounding well and soil logs. There is no documentation of the septic system constructed on lot 2 but it is assumed to have been constructed during the same time that the well on lot 3 was drilled. Based upon this review it appears that these systems were constructed in accordance with the existing regulations and guidelines in effect at the time. However, before further review and/or approval can be granted by this Department the following comments and concerns need to be addressed: Horizontal Separation Distance Waiver; From the submitted information concerning subsurface geology, topography, well construction and water quality as indicated by the analysis for total coliform bacteria and nitrate; a waiver request fo~ a lesser horizontal separation betWeen a class "C" well and the on-site wastewater disl:,osal systems serving Lots tWo (2) and three (3) appears favorable. This class "C" well eppears to be drawing fro,~ a deeper aquifer and analytical results from the submi[ted raw water analysis f3r coliform bacteria was satisfactory and for nitrate was non-detect indicating that the lesser horizontal separation distance betWeen an on-site wastewater disposal system and the class "C" well has not been detr:mental to water quality. Mr. Tobben Spurkland January 25,1996 Page 2 Drinklnq Water Systen3; A review of the submitted information indicates that the well resides in a pit, but does not appear to be susceptible to flooding from surface waters. The submitted well flow test indicates that the well is capable of supplying the daily demand requirements of two residences, however,'at a reported flow rate of six gallons per minute there does not appear to be adequate flow without storage to meet the peak demand requirements for two residences. The well log indicates a greater production from this well can be obtained as evidenced from the reported drawdown and recovery time indicated on well flow test. Therefore, before operation approval can be granted in accordance with ' State Drinking Water Regulations (18 AAC 80.300) the following comments and conditions will need to be addressed: The submitted information did not indicate if storage was available to meet the peak demand requirements of this system. -Storage will need to be provided to meet ~ 20-minute peak demar~d requirement based either upon a flow rate of eight gallons per minute (gpm), fixture unit analysis, or other referenced method. An engineered as-built of the water system under the stamp of a Professional Engineer (P.E.) will need to be submitted to this office. A simple line diagram will suffice, storage tanks and treatment devices will need to be indicated on the diagram. Thank you for your cooperation with this Department, if there are any questions regarding the above please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineer Mi/pt Attachments STYLE : OTHER STORY HT : 1.5 YEAR BUILT : 1978 REMODELED: TOTAL ROOMS: 06 BEDROOMS : 02 FULL BATHS : 2 HALF BTHS: 0 HEAT TYPE : CENTRAL HEAT SYST: HOT WATER FP: STACKS : OPENINGS : EXTRA VALUE: EXTRA VAL: CONDO STYLE: CONDO FLR: GRADE : GOOD CST/DESGN: PA/RCEL: 011-262-13-000-96 RESIDENTIAL SINGLE FAMILY 11/27/95 EXTERIOR WkbLS: STUCCO EFFECTIVE YEAR: 1978 RECREATION RMS: 0 ADD'T FIXTURES: 0 FUEL HEAT TYPE: NATURAL GAS FREE STAND : E-Z SET FIREPL: 1 CONDO COM PROP: CONDITION : AVERAGE BASEMENT : 1,196 FIN/BSMT : 598 BASEMENT GAR: 2 CAR TOTAL 1ST FLOOR : 1,242 2ND FLOOR : 0 3RD FLOOR : 0 AREA: HALF FLOOR: 0 ATTIC AREA: 230 RECROOMAREA: 1955 .............................. ~DITIONAL FEATURES ............................. BASEMENT: 1ST FLOOR: 2ND FLOOR: 3RD FLOOR: AP~EA: COV'RD OPEN PORCH 100 WOOD DECK 70 WOOD DECK 180 Lot2, Block 2, Campbell Point Subdivision had a well and seDtt% system in in 1970 to service the mobtlehome located o_n the propert~.~ ~ ~.-W Drilling, Inc. Jordan/Tho~pBon loo,~ 5ilty Clay Silty Olay~ Sc,oil to mediuz Orovol Fedl~ t~ Coo-sc Bilty ~and {~it~. occatslonal ~e:.~ ::lth Very little Silty ScnJ extol!chi ,~,:t~r~ortn~, 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: Lot 2, Block 2 Campbell Point 11429 Heather Circle J. G. Marson Single Family, Three Bedrooms Class C 218353 FROM MUNICIPAL RECORDS: No Records TANK: Espinosa Concrete 1000 Gal. 2 Standpipes ABSORPTION SYSTEM: Concrete Crib ABSORPTION AREA: SOIL RATING: 85-125 INSTALLATION DATE: WAIVERS GRANTED: Sq. Ft. Late 1960's ADEC to well DATE OF LAST PUMPING: Isaacs September 23, 1998 DATE OF TEST: September 23, 1998 TEST PROCEDURE: House has been vacant for one year with minimal use of septic system. Tank was found with 7 feet of cover and with a liquid level of 40 inebes. Crib was 15 feet deep and dry. 2000 gallons of clean water were added to the crib over a 6.5 hour period. This caused a temporary water depth of 6 inches to me measured in the crib. On September 24 an additional 620 gallons were added to the crib. The crib was dry prior to the addition of water, 2 inches of liquid were measured immediately after adding the water, with in 30 minutes the crib was dry. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactorily for current or future occupants. All septic systems ultimately fail. Some systems last 15-20 years, others fail after less than five years. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907~276-6013 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: Lot 2, Block 2, Campbell Point S/D 8429 Heather Cir. J.G. Marson RESIDENCE: WELL: SEPTIC SYSTEM: Bedroom, Single Family Class C in common with Lot 3, Block 2 Campbell point FROM MUNICIPAL RECORDS: Un documented System TANK: Espionosa Concrete? ABSORPTION SYSTEM: Concrete Crib ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: WAIVERS GRANTED: DATE OF LAST PUMPING: RotoRooter Isaacs;Anchorage Cesspool DATE OF TEST: November 18, 1995 TEST PROCEDURE: System was inspected and measured. Tank was found with 7 feet of cover and with a liquid level of 40 inches. Crib monitor was 15 feet deep with 45 inches of liquid. 600 gallons of clean water was added to the crib at a steady rate of 6 gallons per minute while the water level in the tank and the crib were monitored. The level in the tank did not change while the level in the crib rose 20 inches. After 3 hours the level in the crib had dropped 12 inches, indicating that more than 300 gallons had been absorbed. TEST RESULT: This system meets the operational requirements of the Health and Social Services Department of the Municipality of Anchorage. The physical conditions ofthe tank and the crib can not be evaluated without excavating both. NOTE The operational life ofall septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or ~:stUre. occ.u,p, aflts. All septic systems ultimately fail. Some system~ las.~ 5:20 years, others fail after LOT ~ I I~ I~'ell 4 VACANT 50 I00 150 $CA~£: 1': 100 _[ II 5 VACANT 6 ../ / \ I TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 2 AND S £LOCK £ CAMPBELL POINT J. G. $IA£$ON 8429 H£.4THER ¢IRCL£ S£PTIC SYSTEM LAUOUTS DATE: //0K 21, I,O95 SHEET: I/3 GRID: 2322 TONY KNOWLE$, OOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGEA/VESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 Mr. Tobben Spurkland 203 West 15th Ave., Suite 203 Anchorage, AK 99501 March 29, 1996 (907) 269-7505 SUBJECT: Lots 2 & 3, Block 2 Campbell Point Subdivision - 8439 Heather Circle; Operation Approval Class "C" Public Water System, ADEC Project No. 9621-DW-339-099 and 9621-WV-339-027 Dear Mr. Spurkland: This letter is in response to the information received in this office March 26, 1996, addressing this office's comments concerning operation approval of the Class "C" public water system serving the above- referenced lots. The Department has completed its review of the submitted information which included a well flow test and an engineered as-built diagram of the water system. Based upon this review it appears that the previous concerns outlined by this Department have been adequately addressed· The submitted well flow test verifies that thn system will meet both the peak and daily demand requirements of this water system. Therefore, in accordance with State Drinking Water Regulations (18 AAC 80.300) operational approval of the class 'C' well is granted subject to the following cbmments and conditions: 1. The requested horizontal separation distar, ce waivers between the well on Lot 3 .a..n~d..t.he ?.-site wastewat.er disposal systems on Lot 2 (90 .fe. et) and Lot 3 ~,~ uo met) is granted prowded that no expansion of the residences which increases the number of bedrooms occurs. 2. This water system has been assigned pubic water system identification number (PWSlD qo.) 218453. Please reference this numberwhen sub.m..itt[ng, fut.?re wa..ter sampes s.o that this water system may be properly crea~[ee, wmle routine sampling ~s not required for class 'C" public water systems, annual sampling for coliform bacteria and nitrate is recommend. This approval does not imply the granting of addtional authorizations nor does it ob![gat, e a..ny other state, federal, or local regulatory bod.v to grant reauired aumor,zaaons. Thank you for your cooperation with this Department, if there are any questions regarding the above please do not hesitate to call. ML/pt Attachments RECEIVED · Sincerely,. · .... MichaelLu, E.I.T. ' .. '" Environmental Engineer OCT 'j 1998 Municipality of Anchorage Dept. Health & Human Services Mun]clFallly o! Anchorage DEPARTMENT OF ~EALTH & HUMAN SERVI~E~ - 825 "L" Street. Am:horage, Alaska 99502-0650 ' SOILS LOG - PERCOLATION TEST 2 3 4- 5 6 7 8 10- 11 13- 14.- 15- 16- 17 18 19 20- · .- / .",,,.; .~.- .. ~.; ...... ,-., ~° ~ (ENGINEER'SSF.,~L) '-~ DATE PERPOR.ED=_ Township. Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? [~ O ' ' SITE PLAN F eading Date Gross Net Deoth to Net Time Time Water Drop IF YES. AT WHAT E Oep ~ to Water AIle~l PI[RCOLATION RATE (m,nJtes/mch) PERC HOLE DIAMETER . T-:ST RUN BETWEEN . FT Al'iD. FT DISCLAI · ' ' ndtr~t..~ =.~ '~^. .,. ..... ly. Past and future presence ~,nd/or depth of groundwater can not be predicted . I . ~ -'~ CERT'I~Y THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI, ELINES IN EFFECT ON 1HIS DATE.' DAT;:'.~:' ' O~ ~1 I ~ ~ 72~ (R~. 4/~) 0 ~ ,TI c~ /~z¢# /'e/~ c;:M: ,[ /,rh : £ ,,. ,.,..,.odt /,/o ~.r-°-, __' ~-.~IUNICIPALITY OF. ANCHORAGEs,, DEPARTMEN~ 3F HEALTH AND ENV[RONMENTA !PROTECTION 825 ~ Street, Anchorage, Alaska' 99501 279-2511, ext. 224 or 225 Date Received: ..Au__qust 1t 1977 ~1: Time 2:3Q p.m. ~2: Time 2~30 p.m. Date 8-~-77 Tuesday Insp Kennedy Insp Kennedy ~3: Time Date 8-3-77 Wednesday Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner: Jame$ G. Marson Mailing Address: 8419 Heather Circle Phone: 243=5465 Legal Description: Lot 2 Block 2 Campbell Point Subdivision 8429 Heather Circle Single Family Residence: ~ Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: ® Well System: Permit ~ Construction Individual well (~x Community/Public System ( ) Depth of Well 350' Well Log on File Bacterial Analysis ( ) Se Sewage Permit # Septic Tank Size Absorption Area Disposal System: On-site System Installed 1971 Soils (x~ Public Utility Installer Manufacturer Rate Material ( ) ® Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area page' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 2 Campbell Point Subdivision Co~ents: Affadavit Attached: ( ) Letter Attached: ( ) Disapproved: Date: ~partment Worksheet: 0,' °O JACK BENNY'S AND ANCHORAGE CESSPOOL PUMPING Star Route A, Box 144 ANCHORAGE, ALASKA 99502 Phone 344-2632 or 349-1131 4219 ~ MUNICIPALITY OF ANCHORAG t · ~x~ .-Department of Health and Environmental ~ro~oD.~.7~ & · 825 L Street, Anchorage, Alaska ' 279-2511, ext. 224, 225 -~{equest for Approval of Individual Sewer and Water k'ac~-~t~es e Property Owner: Mailing Address: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: RE.C,E! ED / Phone: Phone: Phone: Street Location: Single Family Residence: ~) Number of Bedrooms: ~ Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual ~ell ~) Public/Community System ( ) If Individual Well, well depth ~ ! If Community System, name of system 8. Sewage Disposal System: On-site System (~) Public System ( ) If On-site System, date of installation: ~ /, ~7/ *NOTE: A well log is required on ALL wells drilled since 6/75. ~/~ 3/77