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HomeMy WebLinkAboutFOX HILL BLK 1 LT 11Bc ' ~ MUNICIPALITY OF ANCHORAGE DE tTMEN'r OF HEALTH AND HUMAN SER EBvironmental Health Division ~ ,b / ~'- 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON=SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TANKS ~'d'~SEPTIC - [~ HOLDIN6 ~--~'~/~'l/~J~-r , ,n II r) ' /Capacty ga o s MatenRI ] NO. ~pmlments TYPE OF SYSTEM TRENCH ~BED ~j W. DRAIN ~ OTHER O,~q ~)j~ FT _~ F'F '~ Fr ~ ¢'/- .C.~~ FT ~p. ,S- FI Gravel width S(~ FI ~ FT ~ St) FT WELLS ~PRIVATE z~ ~ OTHER (Identifv) (A.B.Ci ~ q oral Deplh Casud Id t FT FT REMARKS: DISTANCES TANK FIELD WELL WELL LOT LINE /o/.4 /o/¥ i?~ FOUNDATION ~ / / 5'~' 'v"/A AS-BUiLT DIAGRAM *Shov,, Iocab~r Ll wed ~eph( 5yslem property hne5, loundatlon ScaLe: Inspections Performed by: Date {.~ _ I .~ l~agle RI~oE[~V~ 2~),~ ~ ceflJlyJhal this JnspeclJon was perlormed according to Eaale Rivert Alaska 9~577 / ~ ~ /~ ~ Heal,h Department Approval: .... ~~/~~%_ . ENGINEER'S SEA!.. ! Xi.,'::fl ~)i!!:]!:::;t';: I] I':'I .[ ~!ixl ;', I .t..i I ii. I. .t.'~1 .I.:;] ;I. fi: Ii X I"i .[ 1.1.. ~::ii..!~:.]~i:) ,, i::,l!:x: ,'1 ,, '1 J ','.)N ,, R J. t:]!:!]:! I:';.::'ll.[i..tl:)',l :;-'.i:i,'.i. t::i?! I::' I/i:fl:';; ~:ii! ]I] I. i i'::'::.i i i)l:l;-:' I!..I ',: '!, l.: ! I 1-I :! ~::i :1 !::; :.~!',i lll::'!::l;(~:'~ihl:: iAI:,: ::, ;l:q;:i)l;,ii:ii;it'fl i i:;) I i'I1:, I;:~ X i i:i i :1 Ixli: !]::; l: : l:.-' I :I: i: i~:;'¥'i:~i t 1:~.1'i 37VOS Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ ~EAL) PERFORMED FOR: DATE PERFOF LEGAL DESCRIPTION: ~..--.~? ~ 11 12 13 14 15 16 17 18 19 2O COMMENTS (./'/_~ ~' ~--~¢~ ~/'~/~'~-- Township, Range, Section: SLOPE WAS GROUND WATER ///~ ENCOUNTERED? / ~ S IF YES, AT WHAT ~ .L.L DEPTH? _,~-_/,~_~ ~ ~ Up E Depth lo Waler AFter 5'" Moniloring? z/, Dale: ,~'- ~..~- SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~"/~'~' ~" ~ ' 9' .%" .~ '...a'~, 9'¢* *"* ~- Y~" /" ~ :~ z~ ~ ~ %/" ~ --."/'7¢ (minutes/inch) PE:RC HOLE DIAMETER PERCOLATION RATE TEST RUN BETWEEN O FT AND I - FT PERFORMED BY: ~0a4~.o]..ive. L~...~.~ O~1~:/ ~;' q-~ CERTIFY TH.AT ~IS~ST WAS PERFORMED IN ACCORDANCE WITH ALL STA~E AND MUNi~AL GUiDELi~N E~OT ON THiS DATE. DATE: 72-008 (Rev. 4/85) 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 PHONE []UPGRADE NO, OF BEDROOMS NAME LEGAL DESCRIPTION . LOOATION Well ., . ~- ~ Absorption area ~-. i D STANCETO ~ //~ -- ~ ~ ~ I I ' M ater~ F- ~ I Manufacturer L " ILiq'/L; 6) ~ cap~it~n ~allons IF ~OMEMADE : ~ Inside length,~_ Width I ~'/ Dwelling ~ Manufacturer - ~ I ~ - Well Foundat on Nearest lot line ~1 D~STA~0~TO: I ~ I No, of lines 11 Length of each line g ~/°tallength of lines Trench width ~ Top of tile to finish grade / ~terial beneath tile I Length ¢l ,~ ] Width ~ f Dep.th/ O / ~ ~ ~ Type ~ Crib diameter Crib depth ~ ~l D[STANCETO: Well ]~ O / Building fo~o, ~ ~ IC~a~s Depth _ Driller PERMIT NO. No, of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons PERMIT NO. Distance between lines inches Total effective absorption area inches PERMIT NO. Total effective absoTt,.J~]( /~a~* ~')~L' [¢ Distance to lot line PERMIT NO, Septic tank Absorption area(s) OTHER PIPE MATERIAL~r,,% ~,/C--, SOIL TEST RATING INSTALLER RFMARKS P,O, BOX 272, CHUGIAI<, ALASKA 99567 · TELEPHONE688-27B9 ADDRESS LEGAL DESCRI~IO~,_.~__~:~ DATE. Sta~ed Ended PERMIT NUMilER I)EPTtl OF WELL ~ (2~ - .;. ) ___ STATIC LEVEL OF WATER FT. _L~.~ ~' DRAW DOWN FT. GALS. PER lqR KIND OF CASING KIND OF FORMATION: From,__z___.Ft. t~: .Ft, '"' From Ft. From. Ft. From~Ft. From~Ft. From Ft, Fmm~Ft. From ___ Ft. to ......... Ft ..................................... From ...... r,'t. to_ ...... Ft .......... From Irt, to From .......... Ft. to From ......... Ft. to___ Ft. From ......... Ft. to ...... Ft ............................. From ..... From Ih'om l?rom Ft. to ..........Ft, Itt. to ....... Ft, Ft. to ....... Ft ........................... Ft. to_ ....... Ft. From __Ft, to- ~Ft, From_ From~Ft. to ........ Ft, From .... Irt. to ....... Ft ............................. From .... Ft. to ........ Ft ........... From .... Ft. to ........ Ft ........................... From~Ft. to ...... Ft. l?rom Ft. to ...... Ft .......................... From .... Ft, to. ..... Ft From Ft, to ....... Ft ......... ~.~ From ~_~Ft, to ..... ~,Ft ....... MI$CL. INFORMATION: From ......... Ft. to ...... Ft ............................................ From ...... Ft. to .......... Ft .................................... Frolll ..... Ft. to ....... Ft MUNICIPALITY OF ANCHORAGE Department Health and Environmental rotection 825 L Street, Anchorage, AK. ~501 264-4720 ~ * ~ * HANDWRITTEN PERMIT * * * Permit ~ WELL AND~R ON-SITE SEWER PERMIT Applicant: ~z~U~ ~, 6~/.l~,~Malllng Address: Legal Description: L~+/~. ~/ ~ ~;~ ~- Lot Size: Type of Soil Absorption System Is: Trench: Drainfield:u% Seepage Bed: k(/ Holding Tank~~ Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) Th9 Required Size of the Soil Absorption System Is: , GRAVEL DEPTH , WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pip~ and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = 1~:~_2 GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * ,PERMIT EXPIRES DECEMBER 31, 1 9 * * I cer'tify that: (1) I am familiar with 'the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more.~h~t ~bedrooms. Sign e~: >~_:{.~ ~/~.~ (~/~/F~ ~'~ Is su ed by: ~~ _~~/~. ~_~-~ SWP/024(1/81) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST 1 2 ..... -SITE PLAN 17© 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER I/I-----~' /:/oDE Gross Net Depth to Net Reading Date Time Time Water Drop / ~'-¥ l/,'/V~ '-16~~ '~ -- /~" · ' '' " :." ~' PERCOLATION RATE (--'~/ ,(minutes/inch) :~;::~,',~ ,' :::.',i, ,':";i: :: TEST ~ ~ETWEEN '-~ FT ANO -//' 72-008 ROBERTA. SHAFER May 27, 1987 CIVIL ENGINEER 694-2979 HEALTH AUTRORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENOINEERING STUDIES ANDREf~ORTS WELL INSPECTION & FLOW fESf SITE PLANS ROAO DESIGN SOIL TEST PERCOLATION TEST STRUC] URAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER OISPOSAL SYSTEM DESIGN Ms. Darlene Nicolaysen RE/MAX OF EAGLE RIVER P.O. Box 772849 Eagle River, Alaska 99577 Dear Darlene, REFERENCE: Lot 11; Block I; FoxI~ll Subdivision Your request for a H~alth Authority Approval dated May 13, 1987 cannot be issued. I regret to inform you that our work in attempting to obtain an HAA has shown that the existing absorption system is in non-compliance with the vertical separation distance required between the absorption area and the water table (4 feet). we completed th~ Health Authority r~quirements for the private w~l including a yield test and coliform and ~itrate analysis. The septic tank was pumped and an adequacy test on the absorption area showed that lit was currently functioning adequately, howeve% due to the changes iin water table which has been documented by the Municipality of Anchorage in the Northwoods Subdivision which is in ~ose proximity to this property the Municipality recommended that a monitoring well be installed to determin~ comp£~ance with separation distances. The monitoring tube was installed on May 19, 1987 and after a period of mo~toring for approximately s~ven days it was determined that the vertical separation distance between the bott~ of the absorption bed and the present water table is approximately 12 inches. At your request we are attachin~ an estimate of the cos~ associated with upgrading the absorption area. we are available to assist you in co~tinaing to seek an HAA on this iSpr°perty~ SRB 196X EAGLE R VER, ALASKA 99577 Application Date May 13, 1987 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11; Block I; FoxM~ Sub.vision Location (address or directions) Carl Pale Telephone: Home Business (b) Property Owner Mailing Address_ (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address P.O. BOX 772849, Telephone 694-4200 First Interstate Bank Telephone Anchorage, Alaska/ATTENTION: Shirleen RE/MAX OF EAGLE RIVER - Darlene Nicola~sen Eagle River, Alaska 99577 (e) Mail the HAA to tile followinq address: or; Check here FXI, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING - 694-2979 17034 Eagle River Loop Road, S~.~ 204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms ordered by Darlene Nicolaysen WATER SUPPLY Individual Well ~ Commueity i-] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite)~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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S!ql jo elep .§ MUNICtPALtT¢ O~: ^NCHOI~AGE o£~T, OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENvirONMENtAL pRo3ECT~LTFI AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 3 9 264-4744 ~.CEtVED LegalDescription: ~ // ~ / WELL DATA Well Classification Well Log Presentd~/N) Total Depth /d. cF ' Cased to /~/ ' Static Water Level Casing Height Above Ground / c~ C~ I Electrical Wiring in Conduit ~/?..}N) Separation Distances from Well: To Septic/Holding Tank on Lot // b- ' To Nearest Edge of Absorption Field on Lot /--~ ' -'~' ,~: If A, B, C, D.E.C. Approved (Y/N) )'//"~ Date Completed /.-~ ¢' Yield Depth of Grouting ~ Pump Set At ('/('/~ Sanitary Seal on Casingd~/N) Depression Around Wellhead (Y,~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line A,"/~ To Nearest Public Sewer Cleanout/Manhole /u//~. To Nearest Sewer Service Line on Lot Water Sample Collected by ,-~ '~-~ /_~.z,z'~,.,~.f~-'rZ'~.-t/,/c,- ; Date ~-/c/- Water Sample Test Results ..~¢~'-/5~'~c~--,.,~Zr' ~-¢~. ~o,-~-,~'c,'.~ fi-- Comments ~.-/~ cC ~ c7~ ~_..~ ~E~ ~--~.-¢./,~ ~..~) S '/'-," ',~ ~ B. SEPTIC/H~LDtNG TANK DATA Date Installed ~ Standpipes~/N) Depression over Tank (y~b Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size ,"~.'-¢ No. of Compartments Air-tight Caps(~N) Foundation CleanoutCZTN) Date Last Pumped 3- - --'-,~ - /"I/%- ;for /"//"~' Temporary Holding Tank Permit (Y/N) /cD/./- /0' -/ To Building Foundation ,~/ To Disposal Field /S ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 IRev ~/86~ Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (YN~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /,~ To Building Foundation Lot Type of System Design ~z. E ~/,~T~"~'~ ,~.,'~ Length of Field Depth of Field ~,'. Gravel Bed Thickness Standpipes Present ~)/N) Date of Last Adequacy Test /k/(Z, ¼/ L.,--"- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~7~ W/ To Property Line /o To Existing or Abandoned System on ; On Adjoining Lots 3°/4- To Cutbank (if present) /'"///:) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Cc - ?_&o -ac'3 '2L Dimensions ~ ' X Y '/o "/5/,~, Manhole/Access ,~N) "Pump Off" Level at 2 ~" ~L~ Vent(~/N) Pumping Cycles during Adequacy Test. Meets MOA / ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed$ & $ ENG!NEBRINI6 Date 34 Eagle Rib, er [~(x~p Road No ' Compa_'~, ' ' ~A No. Eagle River~ Alaska ~77 ReceiptNo. ~ / ~ O~¢ ~ Date of Payment ~ ~/~ _ Amount: $ /~ ~ z~ -/ Page 2 of 2 72 026 (Rev 8 861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMEntAL IiEALTH DEPARTMENT OF HEALTH AND ENVIRON~,~NTAL PROTECTION APPLICATION FOR H]'~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (inc. J,ude lot, block,-~ubdivision, section, to~.mship, range) 5'/x _.{t tL / - Location (address or directions) (b) Applicants Name~¥'~/w'~/~?/~,/ ~.0A{,%7~ ieleohone -.. Home Bus,ness Applicants Address (c) Applicant is (check one) Lending Inst{tution I~-~. ' Owner/-~uilder h~'~%} J Buyer L----~ ; Other F~-~ (explain); (d) Lending Institution Telepho ne Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the H~% to the following address: 2. T_~pe of Residence S ingle-F amil Y,f.~I Number of Bedrooms 3. Water Sup_~y_ Individual Well~ Mult i.-Family Community [._--_~ Public Note: If community well system, must have written confirmation from the .State Department of Environmental Conse~*vation attesting to the legality and status. }~ote: ~lf ~/t~D~RmJ. ty t~ell system~ must have written confirmation, from the Sta~e D*pg~tlte:~ of E~tvlror~nental Conser'gation. attesting to t:be legality and status. ~::._.~..,?~ : Engineering Firm Provtdin~ _In~s~ctions, Tests~ File Seareh~_!!Ei~El_!_n~.~!_~.fff~3! As certified by my seal affixed hereto and as of the validation date sho~m 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, functionsl and adequate for the number of bedrooms and type of structure indicated herein° I further verify that, based on the infor~ation 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date DHEP Ap_pr oval_ Approved for Approved Y Telephone ~' T ~ ./~' / ~ ~ ' ;', Disapproved Conditional Terms of Conditional Approval CAUTION THE [,FONICIPALITY OF ANCHORAGE DEPARt~IENT OF TH~AT,TH AND LNV.[2,,,' - n,,,xlL'~, "'\L,uL PRO I'ECTIObl (DtlEP) ISSUES HEALTH AUTHORITY APPROVz~.,CERi ~ '"[~''ICA~ES~' BASED SO~JCLY UPON, TiiE RF, PRESENT-- ATIONS GIVEN IN PARAGRAPI1 5 ABOVE BY AN INDEPENDENT PRO]?I",SS-~]~I%~Ii' ENGI~'tEER Ri~GISTERED IN THE STATE OF ALASKA. THE DiIEP DOES THIS lis A COURTESY TO PUl{CHASERS OF HOHES A~YD THEIR LENDING INSTITUTIONS IN ORDER TO SAI'ISFY CERTAIN FEDERAL AND STATE REQUIRE,- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORF, A CERTIFICATE IS ISSUED. THJ£ MUNICIPALITY OF ~NCHORAGE IS NOT RES?Oi'~SIi~LE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log P~esent ~/N) Legal Description: If A, B, c~ C, D.E.C. Approved(Y/N) Date C~pleted Total Depth /~oO '/6) ~ Cased to Static Water Level /~) t Pump Set At Casing Height Above Ground Elee..t~ical. Wi~ing in COnduit d~/N) separation Distano~s f~.cm Well: To Sept~c/H~t~Li~ Tank on Lot Depth of Groutin.q Sanitary Seal on Casing De,caslon Around Wellhead (__Y~ ; On A~joining Lots /C%E9 To Nearest Edge' o~ Abso=ption Field on Lot /~'~O / ; On Adjoining Lots /~6~3 ~-~ To Ne~es~ ~b].id ~ .Line '~ To ~est ~blie ~ Clean~t/Ma.~Ole ~; ~ ~a~est ~ ~vi~ Li~ on ~t /~ ~ Wate~ S~e Collected ~y.~'~~~/~; ~te .~//O/~ t( Wate~ S~le Test ~sults .~ ~/~ /~-~; Be SEPTIC/~ TANK DATA Date Installed ~,/~hl Size /~)6)~) No. of C~,~a~tm~nts StandpipeS/N) Air-tight Caps ~/N) Foundation Cleanout(~N) Depression o~ Ta~ (Y~ ~te ~st P~d -- ~ . P~ing~aintenan~ Con~a~ ~ File (Y~)' /~ , fo~ ~ Holding Ta~ High-Wate~ Ala~ (Y~) ~- ~ary Holdi~ Tank ]~rmit (.Y~) ~p~ation Distan~s ~ ~ptic~ Tank: To Water-Supply ~11 //~-- ~ To ~ilding Foundation ~] /~.. To ~o~ty Li~ /~ /~ To Dis~sal Field 3--; To ~ter Main/~vi~/Li~ ~ To S~e~, Pond, ~e, ~ Major D~aina~ Co~ Comments [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorp~io~ S ,t~ata Date Installed ~/~/~F. 'Width of Field 3~t Square Feet of Absorption A~ea Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /3/3 / To P~operty Line Length of Field D~pth of Field ~ravel Bed Thickness Standpipes ~esent ~ of ~st A~a~ Test To Building Foundation Lot ; On A~,jQining To Water Main/Service Line ~/~ To Stream/Pond/Lake/c~ Major D~ainage Course To D~iveway, Parking Azea, o~ Vehicle Sto~age A~ea Comments To Existing or Abandoned System cn To Cutbank(if p~,esent) ~//~ 3/M , D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (¥/~N) "Ptm~ On" Level at High Water AlarmLevel at Tested fo~ Electrical Codes(Y/N) Comments ~_ "~p Off" Level at /~// ,Vent (Y/N) /~~ycles ~ ing Adequacy Test. Meets MOA ** Check Permitted Becl~oom Rating Against HAA Request I certify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed' KB1/d5/s Date ~/~/~/' / ' [Page 2 of 2]