HomeMy WebLinkAboutT15N R2W SEC 25 LT 8BOnsite File
tz At's ILI WWAAAeftrA opke- krA I
r...
Municipality of Anchorage
Development Services Department
Building safety Division
On -Site Water and Wastewater Program. 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650 Page •I of3
www.d.anchorage.ak.us (907) 30.}7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 5X3o149.),51 OqO-_ 7,-) PID Number: OSl -a�I
Nene:
1^' DFARvvK Wastewater System: ONew ❑
A"M: Upgrade
170q k (-L2 rjV" Loo/, Ro- C.A. T 5-77 ABSORPTION FIELD
Pnara: fk ro a ee0ro :
01 t/Q - 8 S Tf S- O oaav Tryq tj i94so a Tr. -,M O Bad O mcuw ❑ ouw.
LEGAL DESCRIPTION �R"a I -l")
Ta+oeoeeonuw4yade:
elan:
SN
Well:
ffNew Oupgrade
Te
) 0 Ft.
V b Ft
SV LI i�q o wa; Ea
W4 B4. WalerLM:
w�..s 7/ a)lo y0
YWO:
f O cora
FL
Pn SN aL GYnp Ita'lFa Atwya Growq:
V / K
Inas: awns Uamean Inas:
/ _.
FI.
� FL
SEPARATION DISTANCES
tic
AbsorptionMoldingnk Field
L
7( 1
1
t.1-
M01,
Iif`/i*'
t
o 1
,
_ 1 t
Cwtrn Gran
Ransvks: � `
S
CDMM1 Jil 4'e4)
0z —
Gp l / F.. Ll
PMI Vada' Grava daps earlaaln pee:
3 FI. FI
r. 0+ GnM Larpm: /lam
FI. J O FI.
M+near of
a au+uDaan aM1i: }.00
FlON Ml1 /
7 Fr
�' I Dsla M4tle
6.�eGf �iCcR Ua�� n
TANK
Septic ❑ Holding ❑ S.T.E.P.
+r r.
P/_ /as�rres
NO PE
LIFT STATION
BENCH MARK
'9" X _ .J (
M
O Other.
Gal.
FI.
S i S ENGINEERING
Inspections Performed by: 17094 E&qk Rlver Loop Road, N�M: tg'�%D31 r" a
�-'
11 Developm Department A i ROBERT c COWAN
nt Services De I<
P Approval �+�, �l� cjj�.Baot
Reviewed and approved by: Dttt�tti�i � �/..,F �Or •''
IRev 1aa0) ate: i
n.
FI.
Inas: awns Uamean Inas:
/ _.
a au+uDaan aM1i: }.00
FlON Ml1 /
7 Fr
�' I Dsla M4tle
6.�eGf �iCcR Ua�� n
TANK
Septic ❑ Holding ❑ S.T.E.P.
+r r.
P/_ /as�rres
NO PE
LIFT STATION
BENCH MARK
'9" X _ .J (
M
O Other.
Gal.
FI.
S i S ENGINEERING
Inspections Performed by: 17094 E&qk Rlver Loop Road, N�M: tg'�%D31 r" a
�-'
11 Developm Department A i ROBERT c COWAN
nt Services De I<
P Approval �+�, �l� cjj�.Baot
Reviewed and approved by: Dttt�tti�i � �/..,F �Or •''
IRev 1aa0) ate: i
n.
PERMIT N0. SWO30199
PACE 2 OF 3
Municipalitof Anchora e
DEPARTMENT OF HEAUH AND HUR N SERVICES
P.C.BEN VI6RONMENTALSSER ka VICES D650 0 II DIVISION _4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 8B, SECTION 25. T15N R2W P.I.D. N0. 051-281-09
PERMIT NO. SW030199
PACE 3 of 3
Municipalit of Anchorage
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 96650 : 343-4744
ON—SITE WASTEWATER DISPOSAL SYSTEM e, Ataska 1AND/OR 9-6650 0 eIWPELLe INSPECTION REPORT
LEGAL LOT 8B, SECTION 25, T15N R2W P.I.D. NO. 051-281-09
ST1 ST2
98.3'
FINAL GRADE
2" INSULATION
NEW
94 1'
1300 GALLON
POLYETHYLENE
93.8'
SEPTIC TANK
CO1
hgT2 CO2
MTl CO1 = 97.8'
5 29 0
CO2 = 98.2'
.0 38.0
FINAL GRADE
0 41.0
0 37.0
5 45.0
@34.585.0
0 45.5
CO1 = g2,g'
5 45.0
SR
CO2 = 92.9'
0 85.0
5 85.0
MT2 = 88.8'
MTl = 89.7'
N. T. &
NO WATER FOUND
;.�`
81.8 B.O.H.
r�
�� 9f„� ROBERT C. COWAN �
r
(Urfiffifeb ng
log
by
DOC CO. dba
SULL AN WATER VVELLS
IV
P.O. 13OX 670272, CHt3G1Ak, ALASKA 99567 a TELEPHONE 688-
OWNER OF LAND: $-.)1j'" BORE HOLE DATA
DEPTH
ADDRESS:
From To
LEGAL DESCRIPTION: `7 f�
U
C 04s,
DATE:� �
I
•�. /j '� y/( 0, t„
PERMIT NUMBER: 0 /T91. Date of Issue
TAX IDENTIFICATION NUMBER.oZY 01
Lr1
2o-
chi. Pf
Is well located at approved permit location? 4j--Y6s No
U
fo-t9-JV
6X *,4-J(„C
Method of Drilling:ai rotary rotary J cable tool
Depth of well: / 4
t�
Casing Type .5 �'� IS Wall Thickness {� 5-inches
1%5
14 VJ-r,)-Ila
Diameter _ inches, depth/ C) 3 feet
/
-0 S r
yfj '25-
A P4 71;
Liner Type:
Casing Stickup Above Ground: ' feet
•--o
Static Water Level: C feet
Recover Rate: gpm
Method of Testing: 1
Well Intake Opening Type: U open end 41-ep6n hole
`J Screened; Start feet Stopped - feet
I erforations Start10 feet St Aped E feet
rte" % Y" <! �`1' 441
,,,,Grout Type. Volume 0 u
Depth: from feet, to feet
Well Disinfected Upon Completion? �t'i�es D No
Method of Disinfection:
Comments:
SEP-
Driller's Name
w ~—
ATTENTION: It is the responsibility ,of the property owner to submit a copy of the
well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
01/01/1999 00:00 6882259 SULLIVAN PAGE 01/01
certitf eb 7miatlum ona log
by
MC00.dba
SULLIVAN WATER WELLS
P0.90=027 CHUGUUC, ALASKA 09567 •
OWNER OF t aero L MWA± ~ WJ14: , � .
MebodolTest'.,g_ 44-
v"
-
v" kclaloe Opeting 7ypec O open acid C l open Nola
:1samoccet. Slit i0d Sopped leen
0Pei atom StaA feet Stopped W
coyl
CIMAType 190 n-e„rkT,L —vvok"m /eo 1.AS-
Deott ivm D feet. to %lo- feet
MOBgdC(dsrdaGNOK—�Ita.41.J� •l r%I'��
C r46 r.J6 S T ir-J)o
0 J g'rt djpy16'r�)
Ci -W? 3 6.4.r.Jg�,
Cruet; d'4.4jq�,ai/JS'i,
s,�.s�o�ror.0
1tr f,,.u4s Ta � - u3�4T6�
Ofiia$ �'ter11R ��11 ,.l�tr
1 - • i •.• • - . W . ..• • 1 •. .• 1 • •.� 4 .. •..,
Hil�of�Jr .O.*
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SEWARD 6
SC -E'
FOLLOWING DESCRIBED PROPERTY:
LoTP,�jC[` ZS T/S�!/AZIT/
AND TFaT NO EN63 QACHViNTS
DATE:
EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THEOWN
DETERMINE THISR OF ANY
EASEMENTS COVENA TSE
GRIDN�7s?
RSTRI TIONSTENCE
WHICH DO NOT APPEAR ON THE RECORDED
SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES,
/oz -z7
OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN:
m
a
-*:w.a�
rP�EO"LFA
Du ne erk word
LS -6918 kr
:o•. COQ IF
O
{ �
.0)
°` r Ir ��
Municipality ofAnchorage
\\� 1� r7// P.O. ba 190W • Anchora�;c, Alaska 9'951&6650 • Telephone (907) 3138301 • Fux (!M)7) 33,3.&OO
\\\���/// 4700 Dorgan• Street • Anchorage, Aluska 99507
Mayor Mark Begich A�V.munl.org
Building Safety Division
2/16/2005
S&S Engineering
17034 North Eagle River Loop, Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for T15N, R2W, Section 25, Lot 8B
Waiver Request #WR050008
Parcel ID #051-281-09
Permit # SWO40272
Dear Mr. 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
0.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any fixture 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,
Julie Makela, P.E.
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
+.r Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WROS0008 PID#:051-281-09 HA#:_ Permit#:SWO40272
Date Received: 212/2005
Legal Descr(phon: T15N. R2W, Section 25, Lot 8B
Engineer. S&S Enaineedna
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: 4I 14&=5 By. 4. 0 . k M Q, Q.
Name of Reviewer
..............................................................................
Rec#: 83318 Amount $175.00 Dale Paid: 14? 1Y005
S&
February 1, 2005
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
NE&TNALTTHORIn'
APPROVALS
MUNICIPALITY OF ANCHORAGE
SEWERIWATER
Development Services Department '
�`"NOTESO"�
P.O. Box 196650
Anchorage, Alaska 99519
SEWERS WATER
INSPECTION
REFERENCE: Lot 8B, T15N, R2W, Section 25, S.M.
U40WEAWGSRZES
AND REPORTS
Request q you grant a waiver on the referenced property for the horizontal
separation distance between the existing trench and the west property line at zero
feet.
WELLINSPECTION
S iIOW TFSi
We do not anticipate any adverse effects on the adjacent properties.
If you require additional information, please contact us.
SITEPLANS
Sincerely,
ROAD DESIGN
Robert C. Cowan, P.E.
SOIL TEST
RCC/jhm
PERCOLATION
TEST
STRUCTURALS
MECK4NICAL
INSPECTIONS
Waiver Fees: 175.00
Date of Payment: 2/2/05
Receipt 8: 63316
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SWO40272
Legal Description: T15N R2W SECTION 25 LOT 88"f
Design Engineer: 0003 S & S Engineering
Owner Name: LINDA WIRKUS
Owner Address: 10900 CORRIE WAY
EAGLE RIVER. A 99577 -
Date Issued: Jul 20, 2004
Expiration Date: Jul 20, 2005
Parcel ID: 051-281-94
Site Address: 18274 HILLCREST DR
Lot Size: 43223 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit Is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Welt ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( IBAAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By
Date: _7& la 7/
Date: ???u cy
Municipality of Anchorage
• Development Services Department -
Building Safety DivisionX.�;
On -Site Water and Wastewater Program s r
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904 IV,S -0 Or/ - Z$1- oy
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _(SSI ' Z 81 y Permit Number SW
Property owner(s) Z_i4NFrank- � 1 Day phone � q0 _,g505
Mailing address (1) 10 lQ A 00 (o rr� WaV
Mailing address (2) �IQA le IC r ✓P/ �,i�l� Zip Code 225777
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size `f 3, W3 _A"4/S .F
THIS APPLICATION IS FOR:
Number of Bedrooms T
Sewer Only ❑ Well Only
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
Z
(Signature of property owner or authorized agent)
Permit Fees: f 1'7S. ` Waiver Fees:
Date of Payment: i (R /0'V Date of Payment:
Receipt Number: 0 S s' 0 o V n Receipt Number:
(Rev. 12100) j '
S d S ENGINEERING
17034 Eayh River Loop Road No. 2o4
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)694-2979
July 8, 2004 FAX(907)694-1211
NE&TNA1RHOWTY MUNICIPALITY OF ANCHORAGE
APPROVALS Development Services Department
P.O. Box 196650
Anchorage, AK 99519
SEWER& WATER
MQNC(MNSIGNS REFERENCE: Lot 8B, Section 25, TI 5N, R2W, S.M.
SEWER&WATER It is requested that you issue a permit to install a new well to sery
Ee the existing 4
D' ' bedroom dwelling on the referenced property. rty. The existing well has been flushed and
still has not cleared up.
ENGINEERNGSRAIES We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
ANO REPORTS areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
WELLNSPECTION
MOWTEST If you require additional information, please contact us.
Sincerely,
SITE PLANS
RG,,oDESIG„ Robert C. Cowan, P.E.
RCC/bj j
Enclosure
Wk TEST
PERCGUTION
TEST
STRUCtURAL&
WCHANICAL
INSPECTIONS
ONSTIE
WASTEWATER
CISPOSALSYSTEA1
DESK,
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 18, 2003
Expiration Date: Jun 17, 2004
Permit Number: SW030199 Parcel ID: 051-281-09
Legal Description: T1 SN R2W Lot 8 Section 25
Design Engineer. 0003 S & S Engineering Site Address: 16323 Shims St
Owner Name: Linda Frank Lot Size: 108900 SQ. FT.
Owner Address: 17043 Eagle River Loop Road Total Bedrooms: 4 Permit Bedrooms: 4
Eagle River, AK 99577 -
This permit is for the construction of.
❑✓ Disposal Field Q✓ Septic Tank E] Holding Tank E] Privy Q Private Well Water Storage
All construction must 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 (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
/$ 03
Date: 8
Alttttic:llidlifty,of Alidlot-age
w a Tv.
• tjoblooltielit tov6s bepattitielit
bUilding Safely bivision � -
on -Site Walet and Wasle"Ier Program
4700 South bragaw SI.
P.O. box 196650 Anclrotage, Ak 99519-6650
www.cl.anthotage.ak.Us
(907)343-7904
ON-SITE Si=WERMELL PERMIT APPLICATION
hoR A SINGLt FAMILY LIWELLING
Parcel I.D. n �1 _ C,1s' "I permit Number SW
V
Property owner(s) I Z -� r,% T;G .d o& bay phone
iviailing address (1) I '� D L -I —`:>'F • i? • ( Q (--)Q r A
Aaa ii a`adress (2) StA,:t V" S S4 , Zip Code
Legal description (Lot, Block & Sub'd.) _ L1�4
Legal description (Section, Towhshlp & hange) S eef iop D5.,T l5)V Int L'0+ �S
Lot Slzej>,k�gc6 d Pld Pl. Number of Bedrooms
tNls APPLICATION Is P'Oh:
Sewer Only [I Well Only
Sewer and Well t4 Water Storage
Sewer Upgrade CI
tN15 hhOPI=RtY 13ONTAINS:
Not tub 0 Jacuzzi
Swimming Pool 0 Water Softening Unit
therapy Pool d
I cattily that the above Intormattoh Is correct. 161het cedity that -i ils plicati
btfigle Family b*eft4 id and Is in accotdphce With applicable juitinicipal odes.
/ A(r
owher of authorized agent)
Petmil trees:
bale of Payment: t� 3
hecelpt Number:3�Z
triev. 42=)
Walvet Pees:
bale bf Payment:
hecbipl Ndinber:
■
�■
Is being made for a
NEALTNARNORITY
APPRGVHS
SEWER 6 WATER
LNNE7(TENSIONS
SEWERSWATER
NSPECTION
ENGNEERNG STUMS
AMTREPORTS
WELLNSPECITON
S FLOW TEST
SITE PLANS
—�719
SOS.TEST
PERCOLATIM
TEST
STR XMA& L
IiCNANICAL
NSPECTIONS
ONSITE
WASTEWATER
0(SPOSN.SYSTEY
DESIGN
HG
June 12,2003
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 8, Section 25, TISN, R2W, S.M.
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694.1211
It is requested that you issue a permit to install a well and septic system to serve the
proposed 4 bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test performed. The approximate location of
the test hole is located on the attached site plan. At the time of excavation 5/29/03, no
water was found. After monitoring, ground water was not found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the' installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
17034 NORTH EAGLE RNER LOOP i SURE 204 i6 EAGLE RIVER ALASKA 99577
DESIGN SITE -PLAN
I
---------------------
SHIMS
--------------------
SHIMS STREET
----- 50'_BLM ROW & UTILITY EASEMENT -------------
o
7
rri
Io
`<
t
I H� Z
Il r
rn
S m0
C
'
O°
(�
C
ly
m
Il�u
----- 50'_BLM ROW & UTILITY EASEMENT -------------
A 71
mmm
omo
coO
A
,om
rc)
o
a
o
y
Io
`<
t
9
mo
+
m
cn
S m0
;u r
'
O°
I9..
C
ly
.a
Il�u
N p
C
OC)o
O -U
Im
nxZ
DNC -?
F
S
I I
y
I...yy TI
~
Im
�• ISI
$
Im
D
�
7
I�
hal �
I
'I
L�
a
PROPOSED DRIVEWAY
A 71
mmm
omo
coO
A
,om
rc)
x
r
cn
1-3
tv
N
i --I
C
t�
w
I
I
r I
a
o
y
A�E6
t
O O
O -m C-7
+
m
cn
x
r
cn
1-3
tv
N
i --I
C
t�
w
0) N A d
O O
O -m C-7
+
m
cn
r�
;u r
C
.a
Il�u
N p
C
OC)o
O -U
cn
DNC -?
TIO O h
n
I...yy TI
~
m >
O
A
D
�
7
v
�
L�
a
Y �
m
Cil
O
I
O
M1'
W
UQ
{pam0
�t
Vl
J AZ
r
oc
Z_x
y KIA
^r
A
T
s
sl:�p
�O
O
Z
O
MuOF I1 A of I & IIU apo
bEpAFl7MEN7 OF I IEALII 18 IIUMAN SEFlVICES
025 t* Stied, Aflchotagd, Alaska 99502-0050
SOILS Lo�c — PEnCOLATION TFST
PFIIFOnMED Fon: /L/��1'CC / /Q'!'ly` DALE PEnFI
LEGAL uescnlrNoflGO % g,, �C'C Z�/SzslHanpa, Section: !>/1qo
COMMENTS
D2 /641
C�� 11j
15.0. H
PEhFOnma)tm
ACconDANCE Willi ALL STATE AND
12 TWO Inev. 41051
A
SLOPE SITE PLAN
Gori R IM,11M
17a. If��
WAS
ENCOUN EnED? en � f17
ENCOl1NTEIlE07 .L= _
S _
IF YES, At WI IAT / L
DEPTH? O
P — — — — — — — — —bip—
E
fAm b wool Met
IAnn—
llodnpT fle. — —
neadhq
Dale
ZZ, t
Net
Depth to
Not
Time
flow
Weta
Drop
T
r.
L
C7L7�
�✓
L�!G"d
PEIICULATION hAIE ��/ pmnulevn¢hI PEnC110tE DIAMEIEll
6
IESlhUN0E1WEEN,71-At)) (5 f
CEh11FY tllAI 11115 ICS) WAS PEIIFOIIMEDIff
Ifl Ey CT ON 11115 DATE. DATE: