Loading...
HomeMy WebLinkAboutHERITAGE PARK BLK 1 LT 19Onsite File Heritage Park Block 1 Lot 19 #050-211-47 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211112 PID Number: 050-211-47 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Jason and Carolyn Smith %SORPTION FIELD p Trench El Wide Trench ❑ Bed ❑ Mound Site Address 10413 Tradition Ave Eagle River ❑Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 5 PD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from origin rade t. Gravel depth beneath pipe Ft. Subdivision Block Lot Heritage Park 1 19 Fill added above original grade!�: Ft. ngth Ft. w Tonship Range Section Gravel width Ft. Beds: Number of Lines ance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betwe trenches From Tank Field Tank Line Ftz Ft. Well >100' na na na na TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water >100' na na na Material Number of compartments Lot Line >10' na na na NA plastic 2 Foundation 7,5' na na na LIP-11F-STATION Manufacturer Capacity Remarks Gal. Alarm location Electrics ' [led by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer JRs septic Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 15ectio' 7/7/2021 7/8/2021 Location and description 2�a 3'd 4th bottom of siding at point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �, ,1 Conditional Approval: Date .0 .:4 �� o'w,)�•� g. ............ .......... a! T2 9� •bete 1ApprovedDate Septic System axn�o 10/27/;.021 Note: this approval does not include well permit requirements. trcev uo/uzna/ THIS PROPERTY AND SURROUNDING PROPERTIES ARE SERVED BY AWWU AND THERE ARE NO WELLS WITHIN 100'. )WV _y—X—Y—Y—Y—Y— LOT 1 I I .I 13 DECK NEW SEPTIC TANK DECK SUPPORT IS >5' A WAY FROM _ TANK_ �T 5 BR HOUSE 7.5 30" C CA SLOPE 4% DECK AT GRADE I NEIGHBORING SEPTIC IS FROM PROPERTY LINE --7 SUMP 5.3 EXISTING 32' x 36" x 7' EFFECTIVE DEPTH TRENCH 10' UTILITY EASEMENT > 10' SCOPE OF WORK 1. EXISTING SEPTIC TANK WAS REMOVED. T LOT 9 1. NEW 1,500 GALLON PLASTIC SEPTIC TANK WAS INSTALLED AND CONNECTED TO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. 2. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Record Drawing Prepared for Jason and Carolyn Smith 10413 Tradition Ave, Eagle River Alaska 99577 HERITAGE PARK BLOCK 1 LOT 19 OSP211112 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 DRAWN: 7/28/2021 CSI SCALE: 1 " = 30' PID: 050-211-47 SHEET 2 OF 3 49TH . 0 ............... ... ......................jo Com'. CURTIS TOWNSENDr ® MARK A B SO 21'-2" 32'-6" SV2 23'-11 " 34'-1 " DC01/ 2 24'-11 " 34'-7" SUMP 54'-1' 61'-10" z z w O 0 0 U F— Y oz zo Qo w �w ~z f—Q m Q N W D EXISTING 32' x 36" x 7' EFFECTIVE DEPTH TRENCH THE NEW TANK WAS PLACED 7.5' AWAY FROM THE FOUNDATION. THE DEPTH OF THE FOUNDATION WAS CONFIRMED IN THE CRAWLSPACE IN THIS AREA. THE TANK WAS PLACED A MINIMUM OF 5' AWAY FROM DECK SUPPORTS UNDER A DECK > 30" ABOVE GRADE, AND NOT BELOW THE DECK THAT IS < 30" ABOVE GRADE. Record Drowing Prepared for Jason and Carolyn Smith 10413 Tradition Ave, Eagle River Alaska 99577 HERITAGE PARK BLOCK 1 LOT 19 OSP211112 EKLUTNA ENGINEERING, 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 LLC IDATE: 7/28/2021 DRAWN: CLT SCALE: 1" = 5' PID: 050-211-47 SHEET 3 OF 3 V •••'v # V �® 49TH . •0 ................. ......................... i 0 ................ ............. I... �y.0 c� CURTIS TOWNSEND: 0 No. C 11904 �®AV 0 -1 C0 - - - - - - - - - - - -13- > P - - - - - -10 - - — - - - - - - - - - - — - - - ' UTILITY EASEMENT > r F IE " A 0 ;v F1 r-" 0 mz;� -4- a. A VE01 ROA D Z'� ?Q 0) M04P X , P- 'S- AV AR w ON 0 - . UPPER > z 'ff *�j , 0, r- tj m 0> m 0 x r mcu 0 '9' TWO 6 TO)e Y, > A zo WOOD FRAME\N m (0 tom F K 0 C� 4V 0T 0 fir ;u > > x (n ® _q < (0 04' r%4 P4 C< 0) CD;u 0 '280 w ri rri m rn NORTH CDOD rTj j5 xx x z cu 0 :E 0 Ln CD. =r o CL <D -6- < 97� Id Q x x < (D (D 3 o :�E - 0 E3 :3 cD -a cD o :3 Q@ < > M-1 m rn a m qp '07 110.00' So0,V07"W n (n. 30' z Z -��m- IQ ol s'• >1 o 6— (D 0 IDC> ID :c > m< CL CD <D m --i > ;u >> 1 10 m oog. co o a (D CD CL (D > <D Ti (D )> c1, rt a • m ca 0 cu 000 17- Ln In o --a m 0 o cD co CL cL QID cb cD CD =3- cD ED O (D z cl o (D (D < (D m 0- co o. o co 136" 130, HILLCREST LANE (C) C0 - - - - - - - - - - - - - - - - -10 - - — - - - - - - - - - - — - - - ' UTILITY EASEMENT A 0 0 -4- a. A VE01 ROA D N0004'07"E qb.00, (C) - - - - - - - - - - - 0 p 0 0 0 0 -4- w 0 UPPER m x m m C•-) C) '9' TWO 6 TO)e Y, zo WOOD FRAME\N K \HOUSe OD co OZ 91 > r7l > Z _u 9: OD 0 (A 1711 rq C< 01 cn ri rri rn CDOD xx x x -11% r7i le X -6- ;2: Id Q x x m co SOK u :�E - 0 < > M-1 m 2 :r c(:' m m qp '07 110.00' So0,V07"W 30' z Z -��m- IQ s'• mmu co m— __4 m< 0 p 0 0 0 0 -4- w 0 m m m C•-) C) zo K co > r7l > Z _u 9: 0 C) z r_ 0 1711 rq ri rn O xx x -11% le X -6- Id Q x x m co SOK u :�E - 0 m r- -n v z 0 > M-1 m 2 :r c(:' m m qp z Z -��m- IQ mmu co m— __4 m< ;u >> m MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://wvvw.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211112 Work Type: SepticTank Upgrade Tax Code Number: 05021147000 Site Legal Address: HERITAGE PARK BLK 1 LT 19 G:0055 Site Mailing Address: 10413 TRADITION AVE, Eagle River Owner: SMITH JASON J & CAROLYN L Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: rNo..". ent�S n n llel�artmen[ 5/18/2021 5/18/2022 20613 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (ISAAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B) Issued By: s Date: Date: 5 MUNICIPALITY OF ANCHORAGE t_ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 050-211-47 Property owner(s) SMITHm JASON & CAROLYN Day phone Mailing address 10413 Tradition Ave Eagle River AK 99577 Site address 10413 Tradition Ave Eagle River AK 99577 Legal description (Sub'd., Block & Lot) HERITAGE PARK BILK Legal description (Township, Range & Section) Lot Size 20,613 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ 1 LT 19 5 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) El (w/wo AD U) Upgrade � Duplex (D) El F-1 Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Code ("i Z/ - (Signature of property owner or authorized agent) / Permit/Rush Fees:`� `Y 25 Date of Payment: - 2 3 --Z Receipt Number: (�14 7 2�;_ D Permit No. 05P21 )1 1 Z Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211112, Deb Wockenfuss, 05/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211112, Deb Wockenfuss, 05/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211112, Deb Wockenfuss, 05/18/21  'k, /' MUNICIPALITY OF ANCHORAGE ', DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2.64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ] ~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION O NO. OF BEDROOMS  Absorption area Dwelling PERMIT NO. ~ ~ DISTANCE TO: ~ ~ ¢ ~' Materia)~ No. of compartments ~ Manufacturer ~iC[~~' ~L Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons = W~l ~ Foundation ,. J Nearest lot line ~ PERMIT NO. ~ ~ D~STANC[ TO: ~,~ ~t& ~ ~O -- ~ ~ ~ No. of lines L~gt~ of each line Total length of lines Trench width Distance between lines ~ Top of tile to finish grade _ . Material beneath tile ,I Total e~sorptionarea Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: j Class~ ~_/. Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PiPE MATERIALS SOIL TEST INSTALLER R EMAR KS -I APPROVED -- DATE LEGAL 72-013 (Rev. 3/78) ~ MUNICIPALITY OF ANCHORAGE ,,.~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MA~LIN~ ADDRESS LEGAL DESCRIPTION LOCATION I Well~ ~ ~ Absorption area I DISTANCE TO: ~ Z Manufacturer ~ ILiq capacity in galrons Inside length . I '/'>~ O Dwelling O~ I DISTANCE TO: I O~ I Manufacturer ~ I IWell ~ ~.o~ ~ Foundation DISTANCE TO: ~ ~ ~ I No of lines I I Length of each Ing Total length o~ lines  Top of tile to finish grade .~ i Material beneath die I Length Width Depth ( ~ ~ Type of crib Crib diameter Crib depth ~ ~~ Wel~ Building foundation ~ I DISTANCE TO: ~ [CI~ Depth Driller ~ ~ Buildin~ [oundation Sewer line ~I~A~CE TO: Material Width Material Nearest lot line Tre~c,~th ?¢ 7 PHONE inches NO. OF BEDROOMS PERMIT NO. No. of compartments Liqu. ijJ depth PERMIT NO. Liquid capacity in gallons PERMIT NO. g~o(¢Ol Distance between lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) [] UPGRADE OTHER PIPE MATERIALS SOIL TEST RATING NSTALLER REMARKS APPRO 72-0~3 (Rev. 3/781 LEGAL H !'i'-,! I.r"!UH E:, I .?:';TFtNCE BET!,.!EE:i':i R HELL Fff-,!D FI.N"r' OI",i"'"S ! 'FE ?.';E,h.!RGI'E D :l.E'iEi FEET F'OF: F:i i:'F;:!Vi::!':'~i: HEL.L ',.')Fi: ::[.~SE'i TO 2OE~ FEET LiF'E!N THE T"¢F'E OF' F'UEfl....IC kIEL.!. .... i'"! i N i MLIH D Z :STFiHE:E: FF:OH .,'-'::I F'R I ',,,'FFr'E !4ELL. TO F! Pi:;;: Z VF:! TO i::i C(':q,iMUNiT'?' ':.!~;EF.!EF.: LINE 'i:S 7:5 F'E:ET. EFi"HE.R F:EGLi ! F'.E:iHE!'-,I'F'-::, l"lF!"r' FIF'F'L'T'. SPEC ! ",,-::' :f: (_-'.i::lT ! OJ'qS i:::!H.D C'OHSTF;:L!C'T' {:!',,'!::i!M:iE:LE TO INS!JF.:E" F:'ROF'Ei~: &" .F~iiOINEERS~ INC. PERFORMED FOR: LEGAL DESCRIPTION: 2 5 6 7 8 9 11 12 13 14 17 18 2O 2248-E COMMENTS PERFORMED 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 99503 ;549 - 6561 SOILS LOG [~'~PERCOLATION TEST SOILS LOG - PERCOLATION TEST DATE PEREORMEO: % SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading~ . ~,~ f~ _~,.~ Time Time Water Drop PERCOLATION RATE ~' t -~ (.2 ~/~/-- (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ FT CERTIFIED BY: DATE: 72-008 (6/79) 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 19; Block 1; Heritaqe Park Subdivision Location (site address or directions) 10413 '[~adition, Eagle River, Alaska Property owner Mailing address Lending agency Mailing address Harvey and Linda Magee Day phone 10413 Tradition/ Eaqle River, Alaska 99577 696-3938 Day phone Agent Kathi Olmstead/JACK WHITE COMPANY Day phone Address ]]R?30]~ c]~nn R~ghway, Eaq]P- R~ver, Alaska 995~7 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ '~ TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: 694-5500 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 Pbblic sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. xxx 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify tha investigation of this Health Authority Approval application shows that the on-site water su and/or wastewater disposal system is safe, functional and adequate for the number of bedrc and type of structure indicated herein. I further verify that based on the information obtained the Municipality of Anchorage.files and from my investigation and inspection, the on-site v supply and/or wastewater disposal system is in compliance with all Municipal and State cc ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle River Loop Road No. 204 Engineer's signature DHHS SIGNATURE Approved~ for Disapproved. Phone bedrooms. Conditional approval for bedrooms, with the following stipulatio Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Aut Approval Certificates based only upon the representations given in paragruph 5 above by an indepe 'professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage responsible for errors or omissions in the professional engineeCs work. Legal Description: Municipality of Anchorage '/~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L_l'~ J~LK I flE/'CIF~G£ P/t,~/(~'//.) Parcel I.D. A. WELL DATA Well type /°L//~LI¢- ('t,l~) If A, B, or C, attach ADEC letter. Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ADEC water system number Driller CaSing height Wires properly protected (Y/N) AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank g.p.m ~.~ ~g ~. WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/;I~MI~ TANK DATA Date installed ¢/~ / / Cleanouts ~/N) High water alarm (Y/~)~ Date of pumping Nitrate Tank size Foundation cleanout(~) Other bacteria Collected by: Compartments Depression (Y~_,~ Alarm tested (Y/N) Pumper 7~-~' Pc/"~ICl/J~~- SEPARATION DISTANCES FROM SEPTIC/F:CLD:~'4C TANK TO: Well(s) on lot /b/[~ On adjacent lots ,4./' [,¢~ Foundation /"',~' / Topropertyline ~4:~) /2~ / ~' ~' Absorption field Surface water/drainage ,X~/D~/~-¢' //¢_ ~-_.CC~'J '~ -~Water main/service line 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION ~~..~ Man ufactu rer Size in gallons ~ Manhole/Access (Y/N) ~-~'~/ Vent (Y/N) "P ~ High water alarm level f---'~-~'""--~ycles tested ___ SEPARAT~...D~ANCE FROM LIFT STATION TO: ~ W. n J On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed '7//~ / ¢¢ Length ~ 'P-~' Width Soil rating (~t~" ~%ystem type Gravel thickness F'~ / ~'~'Z. Total depth Cleanouts present~) %~ Date of adequacy test for ~ ~/~ If yes, give date Total absorption area Depression over field (Y~.)~ Results~ail) Peroxide treatment (past 12 months) (Y/N) bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~'~ Surface water /L,/~) ~o,'¢~''- Curtain drain ,/.J0¢'---'~¢%. /(~/,./~¢,..//,~ ' On adjacent lots ,/"C'///~/~ Propertyline /~.3 / To existing or abandoned system on lot ,-,6Y,.~/u~ ~.~¢_..E'~-~-7,~¢'~ Cutbank .A~//..~J~ /¢¢/¢-~d-~7-Watermain/serviceline /~ Driveway, parking/vehicle storage area ,~"' ¢- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on tl~e date of this inspection. 5 ~_,, $ Er'~GINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Signature Engineer's Name Date HAA Fee $ / 7~''~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number ITime L. Time ~. .\ Date Date Date Inspector Inspector Inspector MUNICIPALITY OF ANCHORAGE Comments Conditional Approval DEPT. OF HEALTH ENVIRONMF-NTAL PROTECTION I IAR RECEIVED Date Sewer Installed Permit No, Septic Tank Size ~ _ / ..ii ~.. ~,~,, Holding Tank Size Soils Rating Well To Absorption Area Well Log Received ~ ~'~' Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner J.C. Foster - FOster Hc~es Phone Mailing Address SR 8r Box 1735-K, Anchorage, Ak. 99507 344-7884 Buyer Dev, Gallo~ay Address Lending Institution A].a~ State ]~ Phone Address Nort~ Lights & Denatli, Anchorage, Ak, 277-~661 Realty cO. & Agent ' C-;a.L~e~ o~ ~S~ TJ/c~3a~ Wa.rd ~ '? Phone Address 603 W. Tudor, ~., Anchorage, Ak. 99503 563-3655 Legal Description LOt 19, ]3 1, Her;Ltage Park, Eagle PJLver Street Location 4~h & 'Z~'ac'Li.~ion Ty,P,e of Residence z,, [] Single Family 5 [] Multiple Family '-,, No. of Bedrooms [] Other Water Supply [] Individual ~ .~.. ATTACH WELL LOG. A well log is required for all wells drilled since June 3<~3 Community -~-e.~ ~/A"~.~ , 1975. For wells drilled prior to that date, give well depth (attach log if [] Public Utility available./ S evya.~e Disposal 1882 ~ Individual Year Individual Installed: 1 /:h %