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SEACLIFF BLK 2 LT 4A
�ec�cli�' d1( ZZ/ :50 /-IA 000'"B Ic OC>O HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME--At,,1D MAILING ADDRESS 1'j� j fiUNE LOCATIONE AL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL ` MATERIAL � flu l NUMBER Ja�,K_ ° OMPARTMOENTS ' J LIQUID CAPACITY ��� GALLONS. INSIDE LENGTH �/ INSIDE WIDTH LIQUID f DEPTH SEEPAGE SYSTEM: SEEPAGE PIT NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH A , LENGTH , DEPTH_ LINING MATERIAL DISTANCE �`, +' r. DISTANCE FROM WELLBUILDING FOUNDATION, f f NEAREST LOT LINE �_r TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) TC/ SQ. FT. TILE DRAIN FIELD: /TOTAL LENGTH �/�� DISTANCE FROM WELL FOUNDATION, NEAREST .LOT LINE OF LINES S NUMBER OF LINES/, DISTANCE BETWEEN LINES £— TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA �:J SQ. FT. LENGTH OF EACH LINE %c / DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE.- 1� IN. ABOVE TILE WELL: � c II SL��3�, DISTANCE FROM WATER TYPE DEPTH BUILDING FOUNDATION. SAMPLE , NEAREST NEAREST SEPTIC SEEPAGEOTHER LOT LINE , SEWER LINE—, TANK , SYSTEM- , CESSPOOL , SOURCES_ r \\\r DATE APPROVED �rAZ 7 LiH AU7 Rli rAS UILI 3 A .9 10' UT1L. ESMT. SY17,C 5A BLOG.� W06 ertr 1 \ GREENNouSE �\ o. / Q. •o � . syo of i � o LEGEND ./0A" REBAR FociroD • -%"x 30" REBAR SET NO TES J. EASEMENTS S#VWN ARE FROr/ PLAT ` 65-124- /-?EP/-A7' S-/24%ZEPLA7' of SEACLIFF SV80IVI5I0N 9�io�6S I DWN: J"M w ALASKA CKD: CIVIL EMI DATE: S-13/179 59 A SCALE / /'= 40' ,OPAIENT CONSULTANTS LANDSURVEYORS PLANNERS :SWARD H14HWAY It ~90FESSONAO -vzl DATE OF" SURVE}- S/3//79 195- BU/L T L OT ¢A, BLOCK 2 REPLAi OF SEACL/FF SU/BDIV/S/O/V ANCHORAGES A4-AS/VA FB. _ P -a GRID: 2424 PROJ_ NO- 79048 DWG. / OF moo/\ i Co LONG DRIVE / i 2 STORY 000D 11 FRAME HOUSE Q� coNcRE>•E BL.OGHS 00- IL 6 O ",�, 0, OIL 2ND LEVEL TANK \_ CANT/LEVER /•• •�" O vim;— C EANW M BOO V 7 � 7 �\ o. / Q. •o � . syo of i � o LEGEND ./0A" REBAR FociroD • -%"x 30" REBAR SET NO TES J. EASEMENTS S#VWN ARE FROr/ PLAT ` 65-124- /-?EP/-A7' S-/24%ZEPLA7' of SEACLIFF SV80IVI5I0N 9�io�6S I DWN: J"M w ALASKA CKD: CIVIL EMI DATE: S-13/179 59 A SCALE / /'= 40' ,OPAIENT CONSULTANTS LANDSURVEYORS PLANNERS :SWARD H14HWAY It ~90FESSONAO -vzl DATE OF" SURVE}- S/3//79 195- BU/L T L OT ¢A, BLOCK 2 REPLAi OF SEACL/FF SU/BDIV/S/O/V ANCHORAGES A4-AS/VA FB. _ P -a GRID: 2424 PROJ_ NO- 79048 DWG. / OF Municipality of Anchorage O '' ~�" Development Services Department a.,ti, � ,;�:,., Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. ` ' s' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorge.ak.us (907) 343-7904 CCR T IFICATE.OF 1-iEALTH AU i tiORiTY APP--- — - -- FOR A SINGLE FAMILY UWELONG .. - - - Parcel I.D. 0 I 1—� X 1— 3 O - HAA K--Q� Expiration Date: _ — / (� - Q Lj. 1. GENERAL'INFORMATION Complete legal description Lor 4 A G Lo c -k z S $A C �r Fi= SID Location (site address or directions) Sy R c-2� s 7- D R, q,,, �N• Current Property owner(s) cS\,/H Day phone 'Mailing *address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Wo w zoNG-(1CmAX Dayphone 'D -a-7 —;t3>7 ;t boa CORAoy.4 sT Unless otherwise requested, HAA wN be held by DSD for pickup. 4 k q Cl X-0 2. NUMBER OF BEDROOMS: _ 1� 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well - ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank [] Community Class A' Well ® Community On-site [] Public Water System ❑ Public Serer (l 0 A6 A 3 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certiricates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C we!l and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- :. is(are) safe, hinctional and adequate for the number of site water supply and/or wastewater disposal system bedrooms and type of stricture 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 an wastewater disposal system is(are) in compliance with all appricable Municipal and State codes, ordinances; and regulations in effect at the time of installation... S & S ENGINEERING'; ?1t�5;ir�l7 - X7'9' Mame of Firm ,_�_ .17034 Eagle RiverLoop Road No.;204-". Address Eagle River, Alas lie 99577' +.') ": Engineer's Printed Name o (3�Rr "C` '�!o wAra ` Date 9 03 G *—NINEE�.....:........}. 5. DSD SIGNATURE ROBERT G' Li cs CE�8801... t bedrooms..;%rr�^ �.. _ .•`��r Approved for. _'_ t.� •....:,..•�•:� .... Disapproved. .;> .�;;;: =T ' �Z,Y�y►� :Conditional approval for:bedrooms; with the follovi+ing`stiPulations' - � ...'may J��.I ��•: �.. -�.. - • -- • . \. it nit..• .. i•i ' �1' ::: - . 1.:^ i f''.✓-. . 1.. :3-....:1 . .•rte i?:Gli'. _'d''6'.•:.r; '• `L�"" `\ .�.) • ..� ��. ... . .' •�_, `- fit t, .. .i,•/.• .;, � s ..: •.. ..:.. .• i. :OIC -SITE.'.; Additional Comments' ' • • • •rr 5.• .. :. •WASTEWATER Attachments: HAA Checklist . X Septic System Advisory- . Well Flow Advisory • /J111111)l11�. . Maintenance Agreements Supplemental Engineer's Report .Other By: � _ Original Certificate Date;7—/0 03 I Municipality of Anchorage i Development Services Department Building Safety Division On -Site Water & Wastewater Program s 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-0 i Y A Q 1-0 CIc• X SEg C e_ J J" /= 5/1) Parcel ID: 40/ — a *'41 "' 3 0 A. WELL DATA Well type CC L,4 93 !3 If A, B, or C provide PWSID #c3!o rf $�' Well Log (Y/N) Date completed — Sanitary seal (YIN) _ Wires properl ected (Y/N) Total depth ft. Cased to ft. C height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RF LTS: Coliform _ colonies/100 ml. Nitrate mg./l. Other bacteria colonies/100 ml. I I Arse rng.A. Date of sample: Collected by: _ S. SEPTIC/HOLDING TANK DATA Tank Type/Material •Sii° T► -C 0, C R #- )-*--a- installed 9 1- 6 `1 Tank size 900 gal. NumberofCpmpartments i Cleanouts�l) Y4f -' Foundation cleanout &N) X 13 Depressioq over tank (YQ NO High water alarm (Y/© ^0 O Date of pumpingg/ oZ 8 /o 3 Pumper I S 4A C j C. ABSORPTION FIELp�DATA LRI 8 ?/►> Date installed ) 97 °J Soil rating Lu&dt2 orz/ drm $S System type T RE.r c.N Length ft. Width U/K ft. Gravel below pipe a 8 ft. (:-3 y u Total depth /0 ft. Eff. absorption areayl {C ft Monitoring tube WJ Depression over field N0 Date of adequacy test g/aa/c Results Pass ail) PAJs Forbedrooms Fluid depth in absorption field before test DAY in. Water addeda 0o ogal. New depths 19 0 in* - Elapsed Time: g 00 min. Final fluid depth I!0yin. Absorption rale >= 6100 g.p.d. NaN� Any rejuvenation treatment (past 12 mo.) (Y/N & type) Kms'° "'"' If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump oft level at _ in. High water alarm le in. Datum Cycles tested Meets a circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LO Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public seweup Public sewer manhole/cleanout r /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S �-!•- Property line S /4'" Absorption field 1 4 - Water main )014- Water service line Water / Surface water /00 f" Wells on adjacent lots ?` d o 4 - SEPARATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line �O Cilvrlf/E �uildinfoundation 0 f Water main Water Service line / } Surface water 0 Driveway, parking/vehicle storage Curtain drain Na N#, KNE+ - Wells on adjacent lots 'a-00 �4- -SO 114- F. COMMENTS i.✓ 4 L Nu 17.4 c,e v /� +ti)s UO GAEceNs A3J�R.4ho t+/4't,2 A> 1�TU ,�� OF'4l s -ADAC G. ENGINEER'S CERTIFICATION * 9 �+ y I certify that I have determined through field inspections and review of Municipal records that the above systems are in ,, .... .......... . .......[., conformance with MOA HAA guidelines in effect on this date. , RODER1 C. COWAN ' f Or '^��� �CE - 8801 :.!�`' r Engineer's Printed Name R[ 4/36/Rr Jw9�/ ! � � t. J f ` ,! Date ��a 9/0 3 HAA Fee S 375-. 404 Waiver Fee $ Date of Payment 919-1103 Date of Payment l S lO 3 Receipt Number C�Iy 9 °� S Receipt Number O y/ 6-7 g (Rev. 12/01) Aug, 20. 2003r 5:12PY0 7$REMAX YHUPEI;TMMIZY rlannins x•48 19072431231 KOREAN AIR ANCHORAGE I e+fa Ro~ w>!e ohm y SuRvrf 4= 19 PATMN U ma f0610AM *&dk%T wrw � alq w � WA ad W Now r.�e�KwrrKe�r.�r' 4111- O•r AwF. � , +U dU ral.bMtt G „In vmwwlt .. d not RAY . 1 . *Z -Ml . l . MY ■MMM ... Ts00UPllr UNM 140 cmcwRrmm OW" THC SLW%CTAM R6SFVMUV" m om I+ t tpp PAM 82 • • / lar• W96 r-o ert E . Prof�s Bid Ur. & Assoc. ono Surmyof•c • . �� Aa W Sr. R w ! 0 2003 m' 2003. 2424 "'0 23211 1, 13LCICK 2, SEACLIFy, 6UBDIVISXOX ' IOCnjn XMIAlk1n..w��1o� MANL ASPHALT 9D M CR FlIIAIIGAI q� or 7w WRYD. Ngl�C EARL1a I >datiL , y ia. � mss,. • `� 0p • 30• 1 Lizvjs �N c•el �,, • C. � RNn • L�f Q ON �I11IO j 6 y S4.f ENG, 0 V . O 1 r-o ert E . Prof�s Bid Ur. & Assoc. ono Surmyof•c • . �� Aa W Sr. R w ! 0 2003 m' 2003. 2424 "'0 23211 1, 13LCICK 2, SEACLIFy, 6UBDIVISXOX ' IOCnjn XMIAlk1n..w��1o� MANL ASPHALT 9D M CR FlIIAIIGAI q� or 7w WRYD. Ngl�C EARL1a I >datiL , September 15, 2003 ROBERT 0. COWAN, P.E. WSERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694.2979 FAX(907)694.1211 APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519-6650 SEWER&WATER MAN EXTENSIONS REFERENCE: Lot 4A; Block 2; Seacliff Subdivision SEWECTION Request you grant a waiver on the referenced property for the horizontal separation distance between the crib and the east property line at zero feet. The adjacent property is a Right Of Way, and we do not anticipate any adverse MANEERWGSTUdES AND REPGRTS effects. If you require additional information, please contact us. ''Jqi w. . wELLINSPECTpN 9FLOW TEST .:�•�. Sincerely, :'•"'` r ME PLANS VX Obert C. Cowan, P.E. RCC/ts ROAD E:ESGN SCOW PERCOLATION TEST .r STAWTURAL4 MECHMCAL •. 1S 3' c9.;1G 7$ ONSITE WASTEWATER (/ ;; •. OISPGSALSYSTQA ��. CESKN .. .. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 TOTAL P.03 �:. ... ...... , t ..., Municipality of Anchorage :`,I , " Development Services Department Building Safety Division :`: On -Site Water and Wastewater Program a 4700 Bragaw Street a "' t T " P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 030082 PID#:011-221-30 HA#:3Q 0447 Permit#: Date Received: 9/16/03 Legal Description: §eacliff Block 2 Lot 4A Engineer: S & S Engineering 17034 Eagle River Loon Road Suite 204 Applicant: Sung Suh Waiver Requested: 0 foot Horizontal Separation distance between the Crib and East Property Line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: q'' iD - 3 By: - e of Reviewer Rec#: 41678 Amount: $150.00 Date Paid:N9 6/2003 9/16/2003 Municipality of Anchorage Mark Begich, Mayor Building Safcty Division P.O. Ikax 190080 • 4700 I)ragaw Street Anchorage, Alaska 99519.6050 • (907) 343-8301 • Pax (907) 343-80-00 h ttp://a��a1�'.nuua i.orl; Robert C. Cowan S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Seacliff Block 2 Lot 4A Waiver Request #WR030082 Parcel ID #011-221-30 HA030447 Dear Robert Cowan: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 09 _ j tca OF ON-SITE SEWER AND WATER FACILITY 264-4720 P� Application Date Q 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (addressor directions) D (b) Applicant Name "DE Telephone: Home !AIS Business �, �. ►�� � Applicant Address 2. _Co 1/&e C 9 ssr (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder, ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent 6e1 /A Address Telephone (f) Mail the HAA to the following address: 1 Cie W1 9/1 2 2. TYPE OF RESIDENCE Single -Family Multi-Famil Ot r Number of Bedrooms 3. WATER SUPPLY �/ Individual Well ElCommunity ❑ Publics ' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. it.11i f4. SEWAGE DISPOSAL Onsit'K Public ❑ Community ❑ Holdings Tan�k�❑ 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 1 \ 72-025(11/84) 5. ENGINEERING FIRM PROVIDI" INSPECTIONS, TESTS, FILE SEARCH, 6A -(A AND INFORMATION 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 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. Name of Firm A-)fE' N ( N111 N 1- Q0 hdf Telephone Address 2q t4l ` w I L.I &21 T LAw�. 7 A&jc ":;PA K q S 1.4 Date Q ^ 10 ^ 96 CZ / 6. DHEP APPROVAL y.�1 < Approved for _jCU bedrooms by/, Approved Disapproved Terms of Conditional Approval �Ba a 00000 'a0 aa0° e® o o William Hawl e CE - 7243 ®fL4r�/�yJ °000 es 0°a Conditional Date ate The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representation* 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's work. Page 2 of 2 72-025 (11/84) OHS H'& MUNICIPALITY OF ANCHORAGE (MWV MU�iG1P0�t of .61;:R6LTH AUTHORITY APPROVAL (HAA) 4p t1,ENt� P CHECKLIST -FEBRUARY 1984 t.tw 264-4720 sy,r5Q Legal Description:A—,r? L(! '." K 9 _ eA' lFF A. WELL DATA ,, J QF,►G Lg/ATe2 SYSTEM[ Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Depth of Grouting — Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed 1q6q Size 000 No. of Compartments 4 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cl out (Y/N Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) th /A ; f Holding Tank High -Water Alarm (Y/N) o—_,m Temporary Holding Tank Permit (Y/N) _NA Separation Distances from Septic/Holding Tank: To Water -Supply Well s 4- To Building Foundation I To Property Line l D To Disposal Field i To Water Main/Service Line �� 'l" To Stream, Pond, Lake, or Major Drainage Course (7 n Comments ^`iCQEre 1GPTlC t _ An)rPWZ AJIIQER COWIMC^n% E)CE&MEO To QC.PRjla Pie& i.J R29 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Umeeg T -ALJ - -ARP-h Type of System Design 72 eNC-14 Date Installed 146A • OPGQAOE. Length of Field U 7 02-,, Width of Field UW TI /�K�'(A� Depth of Field 00 �d Gravel Bed Thickness 004)"wi j Square Feet of Absorption Area VA.) tN&J,, Standpipes Present (Y/N) Y Depression over Field (Y/N) (Sc. Date of Last Adequacy Test a -19 -86 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well iso 0,+ To Property Line 10 �t i To Building Foundation To Existing or Abandoned System on Lot N ON I- ; On Adjoining Lots 2 0 + i To Water Main/Service Line 3 + To Cutbank (if present) IS ON l PC?=-SEA)r To Stream/Pond/Lake/or Major Drainage Course NON P yV0 Tlia i0 To Driveway, Parking Area, or Vehicle Storage Area 401+ Comments �_A_ 2(.� S�SiEwt _ {'ciw)!'_Ttn� � (A)MA-L- Lel A IC&AM. J...J D. LIFT STATION M//\ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments 4\�w , T. (-( ftw L tvt c v G 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 tha 1 checl d rified r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company t t^4 0A No. ` Receipt No. l J i� J �� J 4� OF A4 4 $4 �// a je........ Date of Payment�v B�� Amount: $ �`� *�� 4�i ••tom Page 2 of 2 72-026 (11/84) William T. Haw CE - 7248 o -000""0. %,& Nmlo� 1 r-1 F-rH (D' LU I-- 0=3 LUa zz_ 2 T h O c Lr t O t U) 0 " L O t CL H W z C) m (SNOIIVD) NOIld80S9V