HomeMy WebLinkAboutTALUS WEST BLK 1 LT 5Talus West
Block 1
Lot 5
#015-201m=28
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
i
Municipality of Anchorage UPy
On -Site Water and Wastewater Program * (907) 343-7904 NOV dagli 2913of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131110 PID Number: 015-201-28
Dwelling: W Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade
Name:
MICHEAL RZESZUT
ABSORPTION FIELD
❑ Deep Trench 0 Shallow Trench [:]Bed ❑ Mound
Address
4801 TALUS DR ANCHORAGE AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3 *CAT II AWWTS GPD/SF
5.5 FL
LEGAL DESCRIPTION
Depth to pipe invert from original gradeGravel
2.3 FL
depth beneath pipe
3.2 Ft.
Subdivision Block Lot
TALUS WEST 1 5
Fill added above original gradeGravel
0-0.5 Ft.
length
45 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
NA
Distance between lines
I NA Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
a
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
3e)2) Ft2
1
I NA Ft.
Well
>100'
>100'
>100'
>25'
TANK ■ Septic ■ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
BIOCYCLE
Capacity
1500 Gal.
Surface Water
>100'
>100'
>100'
Material
Number of compartments
Lot Line
>5'
10'
>5'
FIBERGLASS
4
NA
Foundation
>5'
>10'
>5'
LIFT STATION
Manufacturer
Capacity
Curtain Drain
>50'
>50'
>50'
BIOCYCLE
1500 Gal.
Remarks EXISTING SEPTIC SYSTEM ABANDONED
Pump on level at
25
Pump off level at
44.5
High water alarm at
22.5
PER UPC REQUIREMENTS
in.
in.
in.
Pump make and model
MEYER
Electrical Inspections performed by
MOA
Installer
PIPE MATERIAL Housetotank 3034 Tanktodrainfield SCH40
A+ HOME SERVICES
Drainfield SCH40 CO/MT 3034
Inspector LARS SPURKLAND
BENCHMARK (Assumed elevation) 100 ft
Inspeecti Sn 1s` 9/9/13 9/9/13
Location and description
2m
3" 9/10/13 41"
BOTTOM SIDING NE CORNER
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
l- ,SN -Nei\\\
Conditional Approval: Date
®! • A. .4
,�
�Q
i CO. '% TJ
49 w
�•.............�
rn'.LA SPURKLAND.: /
Aoorove Date l J�
1`5�
1FES
inspection Rep u-1-12.doc
Septic!
Area
Septic`��
Area 10' UTIL EASE
6
5
0ANDONED EXISTING SEPT D m
TEM PER UPC REOUIRfMf
INSTALLED F.C.O. B
C
4 BDRM
`<7scmc - iox
,LO -F -iux T
CT
A C U S S W E
NOIE.• SLOPES EXCEEDING 25% WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ADSORPTION FIELD LOCATION.
NOTE: TNIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
4—BORM AWWTS CAT 11 S£PT1C SYSTEM
INSTALLED 810CYCLE TREATMENT SYSTEM
TRENCH LENGTH 45 FEET
WIDTH 5 FEET
MAX EXCAVATION DEPTH 5.5 FEET
ROCK DEPTH 3.2 FEET
1 INCH INSULATION
25 0 25 50 75 100 125 150
SCALE, 1' = 50 FT.
0
F.C.O. C 26.5' 3'
BIOCYCLE D 46' 24'
DF. MT. £ 28.5' 29'
DF. M. r. F 65' 48'
SPUNKLANU LNUINLLNING I I TALUS WEST BLK 1 LT 5 I I SEPTIC SYSTEM ASBUILT
203 W 15TH. AVENUE
ANCH. AK. 99501 MIKE RZESZUT DATE. SEPT 25, 2013
(907) 279-3916 4801 TALUS DRIVE SHEET. 1/2 GRID.2736
PERMIT #OSPI31110 PID # 015-201-28 T4LUSVESTBIL5.SC50-ASB.DWG
4' ILMTAP
ASTM 3034
= maH'I I I // DACH FO L
SEVER RUX
2-1/2' NRW
45' �
I SHALL17V TRENCH
NTS
FG ELEV = 101.8' P4 &LY
TOP ROCK £1.£V =99.5' b 4
� w
B17H ELEV =96.3'
DISCIHRGE
FLGIVDDATIAY CLAN 01T
SLA°£ FINISIEO GRAIL AVAY
T�FRAV MPPj IN ALL KREC77W
Y
4' PVC WILUT
m PPRIAWY aMMM
m AERATIAY MN"
iti 0CLAWFIER
T4
®DISCHARGE ChWBER
.WMw A' TANG
AL£DAWD AGI ATIAV
u INSTALLATION
BOH ELEV = 88.8'
1. EXCAVATE A 10' x 10' x 10' DEEP HOLE FOR BIOCYCLE SYSTEM.
2. PLACE A MINIMUM DF 4' SAND OR GRAVEL F17R LEVELING COORS£ IN THE BOTTOM IF THE EXCAVATIDN
COMPACT AS REQUIRED.
1 PLACE 4 SHEETS OF 2' x 8' x 2' BIRECT BURIAL RIGID INSULATION IN T17P DF COMPACTED LEVELING COURSE
TO PROTECT BOTTOM DF FIBERGLASS TANK. TAKE EXTRA CARE TO ASSURE THAT INSULATMV COIRSE IS LEVEL
IN ALL DIRECTIONS
4. BACKFILL ARDUND TANK UP TO INVERT 17F 4' INFLUENT ANB 1-1/4' EFFLUENT LINES VITH FREE-FLOVING NSF
MATERIAL FREE DF LARGE STONES OR BDULBERS.
1-1/4' SCHEDULE 40 PVC V/ 1/8' HOLES P 30'
2-1/2' MINUS SEVER RUCK
SAND/GRAVEL BACKFILL
U
SPURKLAND ENGINEERING TALUS WEST BMK I LOT 5 SEPTIC SYSTEM ASBUILT
203C� LW 15TH. AVENUE MIKE RZESUT DATE. SEPT 25 2013
Ni A151061 11 4001 TALUS ORIV€, ANCNONOC,, AK SHEET.• 2/2 GRID: 2736
PERMIT #OSP 131110 PID # 015-201-28 7ALU9VFSTRlL503-ASBBVc I
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP131110
Tax Code Number:
01520128000
Work Type:
Septic
Permit Effective Dates: July 09, 2013 to July 09, 2014
Design Engineer:
SPURKLAND ENGINEERING
Subdivision:
TALUS WEST
Site Legal Address: TALUS WEST BILK 1 LT 5 G:2736
Owner/Address: RZESZUT MICHAEL &
TOUSIGNANT CAMILLE 4801 TALUS DRIVE ANCHORAGE AK 995160000
Site Mailing Address: 4801 TALUS DR, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank
Lot Size in Sq Ft: 16761
Total Bedrooms: 4
N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
C01 rev -'Ms +1•e 6co"Atl l •
Received
I/' / 7
Issued By: r (N� � Date: 7y
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWERNVELL PERMIT APPLICATION
Parcel I.D. 015-201-28
Property owner(s) MIKE RZESZUT
Day phone 344-9381
Mailing address 4801 TALUS DRIVE. ANCHORAGE, AK 99516
Site address SAME
Legal description (Sub'd., Block & Lot) TALUS WEST BLOCK 1 LOTS
Legal description (Township, Range & Section)
Lot Size Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
E]
Septic Tank
0
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 4
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Upgrade ElDuplex
(D) ❑
Renewal F1Multiple
Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
NONE
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Permit/Rush Fees: 4 5-W - Waiver Fees:
Date of Payment: 5�24� Date of Payment:
Receipt Number: eceipt Number:
Permit No. Waiver No.
Permit App_9 1-12.doc
&,-Ak SparMand
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Talus West Rik 1 Lot 5
Municipality of Anchorage May 17, 2013
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
4801 Talus Drive
Ladies and Gentlemen:
I am writing to request a permit to upgrade the septic system for the above referenced property.
The proposed system will serve a 3 -bedroom single-family residence. The existing system did
not meet COSA operational requirements. A soils log, design calculations, a site plan, design
drawings and construction specifications are enclosed for your review.
Design Calcs: Groundwater observed to a depth of 9.5 feet below
ground surface (5/15/13)
Soil Rating. From Testhole 5/27/97
15 min/in = 3 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 15013 =50 sq.ft.
Total area required: 50 x 4 = 200 sq.ft.
Shallow Trench with 3' effective depth
Minimum trench length: 200/5*.58= 23.2'
System: We are proposing a BioCycle AW WTS, and a shallow trench absorption field. The
absorption field will be 50 feet long and 5 feet wide and contain 3.0 feet (431 sq.ft. effective) of
sewer rock.
Soils: A test hole was excavated on May 27d, 1997 by Tobben Spurkland P.E.. See the
attached soil logs. Ground water was monitored on May 15a', 2013. Ground water was
observed at a depth of 9.5.
Surface Water: No surface waters were observed with 100 feet of the proposed septic system.
203 West 151' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
SpUMand CIMUORMBONno
Environmental Consulting and Design
Topography: The lot slopes to west at approximately 10%.
Waivers: No waivers are required at this time.
The installation of this septic system will not prevent wells and septic systems from being
installed on the adjacent lots. The proposed septic system will not change the general slope of
the area. Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
LLars S urkland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
/
6
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Y I 4 BDRM
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O R E A L S S/ 2
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4 BLOCK 1
— -\ J\ —
TALUS DRIVE\
7 WEST
S -- -- -
TAUr
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/ s 1 5 BLOCK 2 I 4 1 1 1 1 2
G£ego I SII/ I I 1 I 1
NOTE. THIS IS NOT A SURVEYED PUT. WELL & SEPTIC i �O• •�1
LOCATIONS TAKEN FROM ON -SIZE WATER AND WASTE WATER AV 4L 4 t h
DEPARTMENT DOCUMENTAWN. ALL LOCATIONS SHOWN ARE
APPROXIMATE. �•••• ••••••••
Rt....:::.. •�
/ L,RS•SPURKLANO
///�✓' No. CE .11500 __'��� AV
50 D sD 100 150 SCALE 1' = 100 FT, 200 L050 30D �� ��Pi••••
(907) LAND
9 3NGINEERING 916 I I T71LUb' wfl;5'T 1flA 1 LT I I SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE MIKE RZESZUT DATE: MAY 17 2013
NCH AK. 99501
4801 TALUS DRIVE SHEET. 1/3 GR/D: 2736
PERMIT #OSPI110XX PID # 015-201-28 TALUSVESTBIL5.SC100,DVG
J i
Septic)
EE�� Area
Septic�jo
Area II 10' UAL EASE
5 r
4—BDRM AWWTS CAT II SEPTIC SYSTEM
INSTALL BIOCYCL£ TREATMENT SYSTEM
TRENCH LENGTH 45 FEET
WIDTN 5 FEET
MAX EXCAVATION DEPTH 5.5 FEET
ROCK DEPTH 3 FEET
COVER 2 FEET
I
scwc -lax
S
L
TA
NOTE., SLOPES EXCEEDING 25X WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ARSDRPAON FIELD LOCATIOM
NOTE. TNS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION, ALL LOCATIONS SHOWN ARE
APPROXIMATE.
25 0 25 50 75 100 125 150
SCALE., 1' = 50 FT
SPURKLAND ENGINEERINGTALUS BEST BLK 1 LT 5 (I SEPTIC SYSTEM DESIGN
203 W TH. AVENUE
ANCN. AK.K.99501 MIKE RZESZUT DATE. MAY 17, 2013
(903) 939-J916 4801 fALUSS DRIVE' JP7L'rn 211 offlow T3B
PERMIT # 9SP1210XX PID # 015-201-28 TALLIS VES TBIL5.SC50,DVG
Cni
INSTALLATION
1. EXCAVATE A 10' x 10' x 10' BEEP HDL£ FOR BIOCYCLE SYSTEM
2. PLACE A MINIMUM IF 4' SAND DR GRAVEL FOR LEVELAG COURSE IN THE BOTTOM DF THE EXCAVATION.
COMPACT AS RERUNED.
3 PLACE 4 SHEETS IF 2' x 8' x 2' DIRECT BURIAL RIGID INSULATION IN TDP IF COMPACTED LEVELING COURSE
TO PROTECT BOTTOM IF FIBERGLASS TANK. TAKE EXTRA CARE TD ASSURE THAT INSULATION COURSE IS LEVEL
IN ALL DIRECTIONS:
4. BACKFILL AROUND TANK UP TO INVERT OF 4' INFLUENT AND 1-1/4' EFFLUENT LINES WITH FREE-FLOWING NSF
MATERIAL FREE DF LARGE STONES OR BOMBERS
W/ 1/8' HOLES P 30''
O
2-1/2' MINUS SEVER ROCK
r
4 th
twor
ISPURKLAND ENGINEERING TALUS WEST BLIK i LOT 5 (I SEPTIC SYSTEM ASBU/LT
203 W 15TH. AVENUE MIKE RZESUT DATE.' MAY 17, 2013
4 H{ AK 99501 4601 TALUS DRIVE, ANCNORAO€, AK S'N€€Ti 1/3 GRID, 2736
I PERMIT # PID # 015-201-28 TALU9WESTB;L5B3.BW6
FLP,NBmr", CLEAN aur
Maas
A
scars FINISTED r AWAY
caa� m BRAIN
MW IVP IN ALL DIRECTIO4S
2-B! INSlAATIaN
a' KIN
aEaTEXTRf
24' MAX
_
1
o
BACK FILL
2'
� 1/ PVC DISCNiRCf e
1
4' PVC IAFLtEW
0
°
00
SEWER RACK °
4D m PPRAWY CNANAER
T ±, 0 AMA rlW CmNB£R
M/MIS °
'�
�p ® N mCLARIFIER
s H 9DISGWR9' C94MBER
45' —
SHALLOW TRENCH
Tr®Y LF TAN[
...:......... DCLF.LtlWRH DISNATaM
f a'-0" s swB/ce B
NTS
LEVELIAG OWSE.
INSTALLATION
1. EXCAVATE A 10' x 10' x 10' BEEP HDL£ FOR BIOCYCLE SYSTEM
2. PLACE A MINIMUM IF 4' SAND DR GRAVEL FOR LEVELAG COURSE IN THE BOTTOM DF THE EXCAVATION.
COMPACT AS RERUNED.
3 PLACE 4 SHEETS IF 2' x 8' x 2' DIRECT BURIAL RIGID INSULATION IN TDP IF COMPACTED LEVELING COURSE
TO PROTECT BOTTOM IF FIBERGLASS TANK. TAKE EXTRA CARE TD ASSURE THAT INSULATION COURSE IS LEVEL
IN ALL DIRECTIONS:
4. BACKFILL AROUND TANK UP TO INVERT OF 4' INFLUENT AND 1-1/4' EFFLUENT LINES WITH FREE-FLOWING NSF
MATERIAL FREE DF LARGE STONES OR BOMBERS
W/ 1/8' HOLES P 30''
O
2-1/2' MINUS SEVER ROCK
r
4 th
twor
ISPURKLAND ENGINEERING TALUS WEST BLIK i LOT 5 (I SEPTIC SYSTEM ASBU/LT
203 W 15TH. AVENUE MIKE RZESUT DATE.' MAY 17, 2013
4 H{ AK 99501 4601 TALUS DRIVE, ANCNORAO€, AK S'N€€Ti 1/3 GRID, 2736
I PERMIT # PID # 015-201-28 TALU9WESTB;L5B3.BW6
col
Spurkland Engineering
203 W. 15th Ave. Ste. 202A
Anchorage, AK 99501
TEST HOLE f 2_
DEPTH
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOIL LOG AND PERCOLATION TEST
cniL DESCRIPTION DATE._ Aug 26 2013
uics WAS GROUNDWATER OBSERVED: Na
IF YES, AT WHAT DEPTH: Dry
AFTER MONITORING PERIOD: _
DATE OBSERVED: _
fly sm PERCOLATION TEST.•
below 5)
10.H.
FILL
DATE I GROSS TIME
NET TIME
DISTANCE
DROP
6.625
8 26 13 12:44 PM
0 min.
7.500
1:14 PM
30 min.
2.250
4.375
7.250
1:44 PM
30 min.
2813
4.688
2.14 PM
30 min.
2625
4.625
PERCOLATION RATE.• 6.5 minutes/ inch
P£RC HOLE DIAMETER: 6 inches
TEST RUN BETWEEN 4 FT AND 5 FT
SITE PLAN:
N rH�
I cOT 5
4 SIRM HL ;
NOTES.- PRE-SOAKED _
PERFORMED BY. Anson Moxness, 1, Lars Spurkland P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
SPURKLAND ENGINEERING TALUS )MST BLK 1 LT 5 SOIL LOG PERCOLATION TEST
2p0y3�� V 15THAVENUE MIKE RZESZUT DATEt AUGUST 26, 2013
29073 8 9�g *V1 fALYY M, ANEH *AGE; AK Y503ib bm" PeAf i
PERMIT # PID # 015-201-28
`• - (EV YsgF%k§FAL)
F
f F„ yty
Municipality of Anchorage
.�
DEPARTMENT OF !-lEALTH & HUMAN SERVICVS
825 "L" Street, Anchorage, Alaska 99502-0650 i" .T,S :rjXrr.d
SOILS LOG — PERCOLATION TEST'ct"
•: E:v<.
PERFORMED FOR: OLV Wtait4 �p C_ 2 ,Lti� DATE PERFORMED:-
n -
LEGAL DESCRIPTION:
DEPTH 1WELUELL 6v-(7°4NIts
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
WEs i
S&111a� !¢
iuu-I14 PeL6t4y
"'f" r�-tnii.a gonttlC F
SM q>c�;Hy Y(nva�s`�
wi /--t de p l�1
WAS GROUND WATER
ENCOUNTERED?
S
L
O
P
SIS i3 S E
Date:
Section:
SLOPE
INTTo wi C F
1401-c-
IF YES, AT WHAT
DEPTH? c1
Depth Io Water Alter�5
Monitoring? /3
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
Flat,
7 ��
So
If
;13
•
51/6
°e q
>
O
Y
S-7
16
5°
/o ia
°I
' 121
16"
L 0q
Is
u
q
20 I F�
IL_!I PERCOLATION RATE 16 (minutes/inch) PERC HOLE DIAMETER
71
TEST RUN BETWEEN FT AND 7 X FT
DISCLAIMER- Grounrlwatar• Conditions indirated_are for the dates shown only.
Past and future presence and/or depth of groundwater can not be predicted
Com these observations.
PERFORMED BY: 4-5 I _.._ CERTIFY T AT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OATi DATE: AAAA 111 1417
72-008 (Rev. 4/85)
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITYOF
/Y71
OF ANCHORAGE
AND / y /iCNACc /CZ SZUT"
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
lfro Day of SONG of2013, by and between mkctARE.L Xesz,
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
loo(CLe sysmm
located at (legal description).
Lay 5 , 'GLocic 1 , T(-1Lus WesT Sur3-tx\j i %%G )
2. Definitions.
Alteration. Any change to the design or function of an A W WTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations, Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner: MICUAEtr 01 &MtIIQ?USWT
b. Municipality: Director, Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By: �-
-(signature) Date: - �� e I1 , 2613
ICIAA;l_ I<. 1ezes2(-r(printname)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this I174day of TuNE
20 13, byfYl�eWge�iZ.�zesz� .
j,W(-ia46)V4
NOTARY PUBLIC FOR(KLASKA
My Commission expires: - / 0 - / S NOTARY PUBLIC
TRYCA MOYER
STATE OF ALASKA
W OOMMISSION EXPIRES P"L 10, 2D15
MUNICIPALITY:
By: (signature) Date:
name) Title:
GRE ER ANCHORAGE AREA BOf 7GH /
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME '21414 "443 '4-1'610_
�� MAILING ADDRESS #// F/SchGE2,
PHONE
✓���- '`'��
LOCATION LNS �'�:
LEGAL DESCRIPTION 407-
)W} uj U)&3
SEPTIC TANK:
DISTANCE q
FROM WELL Y/GOIJ MANUFACTURER STi}CIL-
INSIDE LENGTH INSIDE WIDTH
SEEPAGE PIT:
NUMBER OF
MATERIAL S TEi5L- COMPARTMENTS
LIQUID DEPTH LIQUID CAPACITY /6-" GALLONS.
NUMBER OF PITS DIAMETER OR WIDTH �? LENGTH 3G 1, DEPTH d
C
LINING MATERIAL s_ d— CRIB SIZE: DIAMETER_DEPTH c DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION NEAREST LOT LINE ZD/� ABSORPTION AREA (WALL AREA) ``-_SQ. FT.
ADDITIONAL ABSORPTION _
WELL:In14,S7' A4eer aeZ—. B/SZ-riAlcE" �'�Giu.//z-EPPJEnITs
TYPE NQjO40' 'TA1*0' J' CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE-
CESSPOOL
INE
CESSPOOL
APPROVED
DISTANCES:
OTHER SOURCES
DISAPPROVED
INSTALLED BY:
%L40,74 EVC4 ).
PIPE MATERIAL: C?n-sT
LOT SLOPE:
REMARKS:
Form No. EQ -031
NEAREST
SEWER LINE ,
DEPTH
SEPTIC quo
TANK %"
DIAGRAM OF SYSTEM
361
tia »�7` X101
�1
U
J� 1
deo P.
/0-U� 3 Ba•�'/
UlPAt �ufLy
X p��Fp
r 1
DATE APPROVED
DISTANCE FROM:
SEEPAGE
SYSTEM
G.A.A.B.
r
�Oj*vee un�aJ
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION _Z
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
AM 6,-./
I MAILING ADDRESS
' h '
V L�
SEEPAGE PIT DRAIN FIELD
PERMIT NO
PHONE) ZL
OTHER
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS "�AiJ/IAL �;0 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
/�.j
COMPLETION DATE ANTICIPATED . / '7 ('(,
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE �� / TYPE SEEPAGE AREA SIZE TYPE `
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
S
FOUNDATION TO SEEPAGE PIT / , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /
SEPTIC TANK SEEPAGE PIT _. DRAIN FIELD 1_U /
TO NEAREST LOT LINE.
�
WELL TO SEPTIC TANK [ DO SEEPAGE PIT �G / ,
DRAIN FIELD 4ao / , ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK /" I SEEPAGE PIT 10 /
DRAIN FIELD /
SEPTIC TANK, .�OIJ� SEEPAGE PIT 1y//,,
(]/ DRAIN FIELD aG/
TO RIVER. LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
/I.
G.A.A.S.
OR
LICENSED DESIGNER
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATUR�
FORM NO. G-016
DIAGRAM OF SYSTEM
AREA BOROUGH ORDINANCE, NO. 28-68 AND THAT THE ABOVE
l
I
I
(
AREA BOROUGH ORDINANCE, NO. 28-68 AND THAT THE ABOVE
l
GRLAIER ANCUURAGL ARLA GURU(
Department of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99503
AUG " --1974 PIS
n
GREATER ANCHORAGE AREA BOROUGH
SOILS LOG - PEROLATION TEST I DEPT. OF E` ENTAL QUA6ITT
Performed for Glacier Excavating Date Performed 8/6/74
Legal Description:O ° e u ivision
This form reports: Soils log a Percolation test
Depth
Feet
I -
FM
RM
4-
5-
6 _ SM 250 SF/BR
12
13
131 Bottom of Pit
14 -
Was ground water encountered? No
S/000
If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate u��• _..
—r------ Yes Drain Field
Proposed installation: Seepage Pit _ _ - —�
Depth of Inlet Depth to l,ottom of pit or trench _
COMMENTS: _ 3i'Ye3room�iou se. No ground water or bedrock enC—C rLU
Certified DY Cnnsr�xctaxi asst -date:,. -&/$/74
Performed Qy:�eal �, Ileu.Uam — a
EQ -040 (6./74)
L)
�._,
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
(address or directions)
(b) Applicants,N"
e ark 4
Applicants Address
(c) Applicant is
Buyer r:: t ;
(,che'd "gone) Lending Institution 0.4ner/builder ;
Other � (explain);
(d) Lending Institution 'yfA_ Telephone
Address
(e) Real Estate Co. & Agent A)//, -
Address
Telephone
2. Type of Residence
Single -Family rt
Multi -Family
Number of Bedrooms j
3. water Suppiz
Individual [Ab11r� Community
Other (describe)
Public F:::4
Note: If ccmninity well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrooms specified in this HAA
4. Sewage Disposal
Onsite FErPublic Community f::j Holding Tank
Is the wastewater disposal system adequate for the rvmber of bedrooms n)
[Page 1 of 21
2-15-84
5. E�ncineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in
effect on the date of this inspection.
Signed
Date V" l k
Name of Firm Telephone
}
Address./?
Signed by
Date V
6. fiEP Approval
Approved for
Approved
694 Qg00001 ® aC ....s.y,Y "M10
(ENGINFER SFAL)
bedrooms By !� ° z a U Date 7�/
Disapproved 4I conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Enviror ental Protection does
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shc-Nin above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedrooms and type of structure indicated.
(DHEP ,SEAL)
7. Mail the HAA to the following address:
r; 'L-Lt;1
�1
KB2/d5/9
e
(Paye 2 of 23
2-15-84
a MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) G A ID I �
CHECKLIST - FEBRUARY 1984 rhRY�L Z�r
A. WELL DATA N011031M 1V1N3WNOdIAN3
V3H dO '1d3a
Well Classification If A, B, or C, D.E.C. Appro
Well Log Present (YN Date Completed Yield as
Total Depthya,/�i�2 --ay/ Cased to Depth of Grouting 6s)11!��1 21
Static Water Level jwwvt Pump Set At.&,D 7
Casing Height Above Ground 21 Sanitary Seal on Casing g2 )
Electrical Wiring in Conduit (/N) Depression Around Wellhead (y4—
Separation
Y )Separation Distances from Well:
To Septic/Holding Tank on Lot //>c) On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 2/pc)/ ; On Adjoining Lots ;>louf
To Nearest Public Sewer Line �IT' To Nearest Public Sewer
Cleanout/Manhole /v� _ To Nearest Sewer Service Line on Loty/14
Water Sample Collected By ; Date 4°�3/
Water Sample Test Rasults S•LiiS C-k1zi'
Ccmmeent ,+ri 1q5 W-[. ��oz.J p$2�2tx.Fs{ u< ,yA, adFa�.c. i_ r.,gr4.
B. SEPTIC/HOLDING TANK DATA
Date Installeeld she'174A( Size _ C) ® No, of `Ccapart tints ?
Standpipes �fls�[N) Air -tight Caps (jN) Foundation C//leanout /N)
Depression over Tank (Y Date Last Pumped
Pumping/Maintenance Contract on File (YIN) 4') ; for
Holding Tank High -Water Alarm (Y/N) LLf- Temporary Holding Tank Permit (YIN) LIA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well �nr)j To Building Foundation IS"7
To Disposal Field /
To Property Lire >a -)l_ po ��
F V....
Fo Nater l"PrService Lire To Stream, Pond, Take, or Major Drainage
[Page 1 of 21
215-84
C. ABSORPTION FIELD DATA
D.
Soils Rating in Absorption Strata �t Type of System Design Lel
Date Installed 4�� Length of Field C?6
Width of Field 2:_>i Depth of Field /.3
Gravel Bed Thickness
Square Feet of Absorption Area _ Standpipes Present �N)
Depression over Field (YA Date of Last Acbquacy Test
Results of Last Adequacy
Separation Distance from Absorption Field:
To Water -Supply Wbll 7/o e3 To Property Line 7/0�
To Building Foundation -f Jo, To Existing or Abandoned System on
Lot 011q_ ; On Adjoining Lots --30/
To Water Main/Service Line AJ14- To Cutbank(if present) 104
To Stream/Pond/Lake/or Major Drainage Course 1V/4
To Driveway, Parking Area, or Vehicle Storages Area �a��we ,�,�� u���=�.- )f L-
Onmment5i5?l omnA iin.G,� -k" 4i0.,-dli,Jt,/9n/7,,.,,,,i".D
Date Installed X)/A _ Dirrensions /��
Size in Gallons J��/4 _ Manhole/Access (YIN)
"Pump On" Level at ��fY _ "Pump Off" Level at
High Water Alarm Level at M It Vent (Y/N) " �¢
Tested for +&tA Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conforrred to all MOA HAA Guidelines in effect
on the date of this inspection. ,p
.
Signed �� �� -_� Date fit'/r �� •i5ihN •� .4�;;'•4s 0
Company �_S _MOA No. C» s+�?��s Rseq
t_ ... E
KBl/d5/s
(Page 2 of 21
oq •..........
by C. Reid, Jr.
No. 9251.9 ,.
2-15-84
_¢� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INCuu"R�
�-TELEPHO E (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER5633 B Street
- seeowerowus
Drinking Wat r Analysis Report for Total Coliform Bacteria
F�
TO BE COMPLETED BY*ATER SUPPLIER
I ' (•)
WATER SYSTEM: See h on back
I.D. N0, _
water System Name I Phone No.,
A r—
City I
tate
SAMPLE DATE: LCA =!1=1
Mo. By Ye
Zip Code
SAMPLE TYPE:
one
Ch clk Sample (for routine sample Treated Water
with lab ref. no. 1
❑ Special Purpose Qa'Gntreated Water.
(
SAMPLE Time Collected
NO. LOCATION collected By.,
�J/ t
2 I LC-- /31
3 (CQor. 1'a,—z ! -- iawl
4
5
06-1220 (b)
_ 1R1ev. 1976
L
Date Collected
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Recelved
TO BE COMPLETED BY LABORATORY
alypis shows this Water SAMPLE to be:
Sat1oactory
❑ Unsatisfactory
❑ Sar'riple too long in transit; sample should
not -be over 48 hours old at examination to
indicate reliable results. Please send new
sarilple via special delivery mail.
Date Recelved
y
Time Received
Analytical Method:
O Fermentation Tube
Membrane Filter
Lab Ref. No. Results Analyst
I ' I m
l m
I I m
I C17
+No. of colonies/100 ml. or No. of Positive Pomona.
BACTERIOLOGICAL WATER ANALYSIS RECORD
fi
t
sourm
a.m.
Nult1p14 Tube Report:_
Ja.mbr.. Fater: Direct
IWrltkatlon: LTB_
final Membrane Fater R
Retorted By
1 \
_Tlme
lofnl
i. Lab. No.
1ono I 10ml 1 1Aml 1 0-Iml
Brom 24 houra; Broth 46 hour•:
16ml Tubae Podtlw/roHI 20ml Portions
ITlIltttttr_ WAri
P.M.
ALASKA 6TUIROW11TAL COIITROL SOdas, Inc.
Cngineerinq & 6nuironmenlal Studies
July 16, 1984
Department of Health & Environmental Protection
825 L. Street
Anchorage Alaska 99501
Attn: Susan Oswald
Subject: Talus West Subdivision Lot 5 Block 1
Dear Susan:
On July 16, 1984, this office re -inspected the subject lot. The system
has a septic tank and not a package plant. The adequacy test report has
been amended (attached).
If this office can be of further assistance, please contact us at
561-5040.
Sincerely,
Larry Montgomery CJ
Environmental Engineer
1200 West 33rd Auenue. Suite a • Anchorage. Alaska 99503 • (907) 5615040
ALASKA RUIR0W11TAL C011TR0L RUINS, Inc.
Engineering & 6nuironmental Studies
MUNICIPALITY OF ANCHORAGE
ENV6' it. '1 .:X. ! :O F
7/21/82 !U"L G " ^ 8 1962
RECEIVED
RONALD TARRINGTON
SRA BOX 1681 R
ANCHORAGE AK 99507
SELLER — RONALD TARRINGTON BUYER—
SUBDIVISION—TALUS WEST BLOCK -1 LOT -5
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 700 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 7/82 .
SEPTIC TANK ADEQUACY
THIS HOUSE HAS A PACKAGE PLANT IN LIEU OF A SEPTIC TANK.
of
,y C. Reid, Jr.
No. 2251•E e
1220 West 25th Auenue • Anchorage, Alaska 99503 • (907) 276-1361
ALASKA MOIROf1UTU WOOL Hkijr CCS, InC.
Engineerinq & Enuironmental Studies
JULY 21 1982
RONALD TARRINGTON
SRA BOX 1681 R
ANCHORAGE AK 99507
SELLER — RONALD TARRINGTON BUYER —
SUBDIVISION — TALUS WEST BLOCK — 1 LOT — 5
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 700 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON7/82 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
ADDITIONAL COMMENTS
AMENDED REPORT 7O ELIMINATE PACKAGE PLANT AS OF JULY 16 1984.
1200 lllest 33rd Auenue, Suite 13 • Anchoraqe. Alaska 99503 • (901) 561-5040
5. LEGAL DESCRIPTION /
✓
l/l"
i
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHOR E
6. TYPE OF RESIDENCE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
•
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
SINGLE FAMILY
ENVIRONMENTAL ENGINEERING DIVISION OCT 10 1979
❑ MULTIPLE FAMILY
Telephone 264.4720
REQUEST FOR
APPROVAL OF INDIVIDUAL WATER AND SEWEREfEUVE
DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
IL
1. PROPERTY
PHONE
MAI 1-1, ADD
❑ PUBLIC UTILITY
PROP RTY ESI DENT (lfjdyferer
from ova)
PHONE
2. BUYER
**If individual/on-site, give installation date 1g1`i.
PHONE
MAILING ADDRESS
❑ PUBLIC UTILITY
3. LENDING INSTITUTION
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION /
✓
l/l"
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
F-1OnejW Four ED Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
-6j] INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
"til INDIVIDUAL/ON-SITE**
**If individual/on-site, give installation date 1g1`i.
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
P
�.-fl�N✓�Cwr/1v. � t�
Y .(ns- vusm�tl/lttJ �%01�9-N^`
V ��
72-010 (Rev. 3/781
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED -
INSPECTION APPOINTMENTS
TIME
TIME TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
"H] SINGLE FAMILY
❑ ONE El THREE ❑ FIVE
❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
M INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
Connection Vei if ed
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
-E71NDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY
Connection Verified
_
INSTALLER
'OSepti^c Tank or or E-1Holding Tank
Size: 1, —If Tank is homemade
SOILS RATING
give dimensions:
All
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MAT
IAL
'
I
QQ
' p
JLfl
_ 81
4. DISTANCES
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
-�-
5.COMMENTS
l_ � A? -
l_CD sz, n!Ar"
�sc l�r�rn ��LaL,
-APPROVED FOR
3> BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
11 DISAPPROVED
DATE
BY (Title)
—`4^�b
_(_ —
LEGA DESCRIPTION
72-010 (Rev. 3/781
CHEMICAL ® GEOLOGICAL LABORATORIES OF AI KA. INC. TELEPHONE
w (907) 279.4014
P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY -LABORATORY
PUBLIC WATER SYSTEM:
I.D. NO.
I t&.- �
Public Watar System Name
Mailing Address -
S�/3� AG L/g'/ITS
SAMPLE DATE: 2--- ( l
Mo. Day Year
SAMPLE TYPE:
❑ Routine
❑ Check Sample (for routine sample El Treated Water
with lab ref. ) El Untreated Water
L1 Special Purposee
SAMPLE Time Collected
NO. LOCATION - Collected By
3
4�
>5
�.a
READ INSTRUCTIONS:_
BEFORE
LABORATORY
NAME
AbDRES$
Date Received /`, —/6
Time Received
Analytical Method:
❑ Fermentation Tube
Cc�Membrane Filter
Lab Ref. No. Result' Analyst
iX00
� ! m
No. of colonies 1100, ml, or No. of Positive Portions.
06-1220(b) - BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
Date Collectw Source
a.m.
Date Received Tlme Received p.m. Lab. No.
.,.e......... �,.e 18m1 1 loml 1 loml I loml loml 1.0m1 0.1ml
Hours
COLLECTING SAMPLE
Multiple Tub. Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane FilteRas
Form No. 18-310 (3-78)
Reported By _`-
Broth 24 hours: Broth 48 hours:
10ml Tubes Positive/Total lOml Portions
p.m.
Tobben Spurkland P.E.
8155 Cranberry St.
Anchorage, Alaska 99502
Phone (907) 243-5302
SEWER A D E g U A C Y TEST
IAT 59 BLOCK 1, TALUS WXST SUBDIVISION
Sandra Bronson
Area Realtors
5437 East Northern Lights Blvd.
Anchorage, Alaska 99504
Residence: 4 bedroom, Splitt level Built in 1976
Water System On Site Well
Sewer System 1000 gallon septic tank, 8x8'log crib with gratel
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
NOV 2 11979
RECEIVED
Date of Test Nov. 20921 1979
Procedures The system was inspected on Nov. 19th. 14 inches of fluid was measuered
in t73e crib. The septic tank was full of sludge with no discernable
strata of water.
On Nov. 20th. the tank was pumped. 13 inches of sludge remained
in the tank at the end of pumping.
The pit was charged with clean water and the following readings
taken:
Water depth prior to test* ..................... 14 inches
Depth after 700 gal intriduced.... 0 ............ 33 inches
Depth after 1000 gal ........................35 inches
Depth after 24 hours .........................111 0
There has been a drop of/5 inches in the 24 hour period. This
drop translates into a leaching rate of Z5gbc-� 1 2�}%n(
The required rate for a 4 bedroom house is 600 gal per 24 hour
This residence does/ deas=aat meet the municipal requirements.
Your
T.Sp kland P.E.
ur At.of
X00
* • 49T0►
......
..................
4: No. 2225-E
JUNE 25, 1911
4 6-
DRI VB
Wiest_!_
10a 4.
November 5, 1979
Sandra Bronson
v Area Realtors
5437 East Northern Lights Boulevard
Anchorage, Alaska 99504
Subject: Lot 5 Block 1 Talus .lest Subdivision
Please include the following with the; items to be completed
in the; .latter of October 15, 1979.
The addition of a 500 gallon septic tants will be
needed. The system, at this time, has only a
1,000 gallon septict tank which is only for a
three(3) bedroom single family dwelling.
If these are any further questions, please contact this
office at 2.64-4720.
Sincerely,
Robert C. Pratt, R.S.
Associates Specialist
Y.CP/l j w
'"A
nc ra-ACv
POUCH 6650
ANCHORAGE, ALASKA 99502
(907) 279-2511
GEORGE M,,. SULLIVAN,
1A YOR
DEPAR I HENT OE HLALi'I1 AND ENV IRONMEN fAL PgOTECTION
1825 "L" Svoe[)
October 15
Sandra Bronson
Area Realtors��
5437 East Northern Lights Boulevard
Anchorage, Alaska '99504
Subject: Lot S Block 1 Talus West Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1 The water was not on in order for this department
to obtain a water sample. Please contact this
office when the water is on so that we may set an
appointment for sampling.
(2) The septic tank pumped with a receipt submitted to
this office.
(3) An adequacy test be performed on the existing leaching
area. This test will determine if the system is adequate
according to National Standards. A listing of private
firms performing the test is enclosed.
Please notify this department for a re -inspection when the
noted descrepancies have been corrected. If there are any
further questions, please contact this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
"WIN IU I I'ALI IT Vi ANUHUNAUL
QEPARTMENk-OF HEALTH AND ENV1R0NMENTn_jP 0TECT10N
Ntt}y iji 825 L Street, Anchoraon. Alaska 99501
��
A 264-4720
Date Received: December 6, 1977
41: Time 3: 0 P. m. 42: Time _111-L�f111� 3
Date 12- /-77 Thursday Date
InspPrt —
Ins
Time J1 LJ �_il2 -
Date
I n s p
RIsQUEST FOR APPROVAL OF INTDIVIDUAL SEWER AND COATER FACILIT LEIS
1. Lending Institution Request: Alaska Mutual Savings Bank
Mailing Address: 601 West 5th Avenue 99501 Phone:
2. Property Owner: Robert Dalby Phone:
Mailing ?address: % Mike Messick, Dynamic Realty, Inc: 279-7611
3. Legal Descri-ption: Lot 5 Block 1 Talus West
4: Single Family Residence: kx) Number of: Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: Individual Well Community/Public System ( )
Permit 4 Depth of Well Well Log on rile ( }
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System kx)Public Utility ( )
Permit _ Installed kms, 0 0 -Astaller
Septic Tank Size Manufacturer. J/ _
Absorption Area.Soils Rate JCS y Material
— _
I
CIA_t -
/
7. Distances: Well to Septic Tank _ to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest. Lot Line
Page Two
Department of Health and I3nvironmental Protection
Request for Approval. of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 1 Talus West Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved: — ----- .._�
Date:
�--
Disapproved.: ------`--�_-- Date: -
Department Worksheet:
?06-1220(.) Rev. 1973 .
DATE
ALAS. ,DEPARTMENT OF HEALTH AND SOCIAL SE,, SES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
INDIVIDUAL ❑ SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM
REPORT RESULTS TO
NAME
r
ADDRESS
CITY ZIP CODE
ADDRESS
OF SOURCE
Lab No. - -
OFFICE
Analysis shows this Water SAMPLE to be:
❑:: Satisfactory
❑ Unsatisfactory
❑ Questionable
❑ Sample too long in transit; sample should not be over 48
hours old at examination to indicate reliable results. Please
.send new sample.
❑ Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS -SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED ' .I TIME COLLECTED
Sample Collected From ❑ Kitchen Tap ❑ Bathroom Tap ❑ Basement Tap
❑ Other (List) _
Well —❑ Dug ❑ Driven ❑ Drilled ❑ Bared
SOURCE: ❑ Spring ❑ Cistern ❑ Other
Dug Well or Cistern Construction: ;
Wells —❑ Wood ❑ Concrete ❑ Metal ❑ Tile Brick or
Top — ❑ Wood ] Concrete ❑ Metal I] Open Top ❑ Concrete
LOCATION:
] In Basement I] Basement Offset ❑ Under House
-
I]In Yard ❑ Other
Building Sewer Septic
-
DISTANCE TO: or Other Drainage Pipe Feet. Tank—Feet,
Tile Seepage Cess -
Field Feet. Pit Feet. Pool Feet. Privy Feet..
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- [] Cast Iron ❑ Wood I] Tile ❑ Fibre ❑ Asbestos
❑ Plastic Joint Material - Type Cement
GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No
When? —
Diameter of Well Depth Feet.
Well Casing -
Material Diameter Depth
Length of Water Depth
Drop Pipe From Bottom Feet.
Offset in In Utility
PUMP LOCATION: ❑ In Well I] Basement ❑ In Basement ❑ Room
- -
On Top
I] Of Well ❑ Other
PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No -
- -
New Sears. of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature _
e ( BACTERIOLOGICAL WATER
ANALYSIS RECORD
Rev.20
R19 3
READ INSTRUCTIONS Data Received %-=`%�T% Time Received '
°m
pm. Lab. No.
Lactose Broth loco loco
Igoe Igoe Igo, 1.0cc 1.0cc
ON 24 Hoar.
48 Hours ----
'-
Brilliant Green
REVERSE SIDE 24 Haar.
48 Hours
EMB
AGAR
BEFORE Lactase Broth, 24 hrs. 48 hrs.—
Gram's stain
Coliform Density -
(Most probable No. per 100cc)
MF Results -.
COLLECTING SAMPLE
Reported by
a.m.
Dale p.m..
_ This analysis indicates Coliform Organisms to be:
Absent -`
- -
Present
1
2
3.
M
5.
( ,,'4UNICIPALITY OF ANCHORAGES'
I)epartment -of Health and Environmental Protection.
825, L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
est for Approval of Individual Sewer and Water Faciii�ies
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Lending Institution:
Mailing Address:
Realtor/Agent:
Mailing Address
Legal Descripti
—Phone:
Street Location: y 7,2 ® 7V.lu-r :D�IVe
6. Single Family Residence: ((Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well (� Public/Community System ( )
/ %9?�
If Individual Well, well depth dts�fj®�I
If Community System, name of system
8. Sewage Disposal System: On-site System (Public System ( )
If On-site System, date of installation: % 9 %S
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
Pt a}CPAa[ CPQ
` � a
a°`+aitla iaamcy ....
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received / - "--,/- 7
Time of Inspection ✓/ //DF>�� >
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & 14ATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:.<,,r;%r,._.. -<-fit; Phone:
2. Property Owner: C ,.fo. r % Phone: _A/,/
�PA+vv 1 �Pt• ,,
Mailing Address Dc..c;' Tti w,
/i
3. Legal Description: �✓ /!/ �/ C<<s �G c.�%
4. Location:
5. Type of facility to be inspected £.�</_,,,< `,r No. of bedrooms
6. Well Data:/g
A. Type .. _ F __<:..,..x>.-^- B. Depth
C. Construction �.�a ruEc� b> 0"P D. Bacterial Analysis oYh
7. Sewage Disposal System:��—���<m._..,
A. Installed Y-1 1-/ B. Installer 51aawti
C. Septic Tank: 1. Size /060 2. Manufacturer Sfac c Sff 1
D. Seepage Pit: 1. Absorption Area y.2 2. Material l600
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank /po' Absorption area i6 G Sewer Lines ,
Nearest lot line 4/0 i Other contamination {1� B. Foundation to septic tank Absorption area yO
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages - Re st for Approval of Individual er & Water Facilities
Legal Description /c4- S
Comments u i"�y�� �?� h eL< d Li / /lti2C j'2'e,6)c��u
Approved 0.&'ty&i(� Disapproved Date / Z�/7,S'
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
c_ y/).� 3!'��
U
,FLy��L
-Iv ,$�,r� {2C.¢rpz�
�.: - ..��-i,r,.'�.:� ��i•a c3't�cC�
Cts
I certifv that the information contained in this reauest for aooroval to be a true anc
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
Q6 -1220(a) Rev. 1973
DATE
INDIVIDUAL ❑.
NAME
CITY
ADDRESS
OF SOURCE
AL DEPARTMENT OF HEALTH AND SOCIAL 'CES
DIVISION OF PUBLIC HEALTH Lab No.
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS OFFICE
SEMI-PUBLIC Lj CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ZIP CODE
Analysis shows this Water SAMPLE to be:
D_�Safisfactory
❑ Unsatisfactory
❑ Questionable
❑ Sample -too long in transit; sample should not be over 48
hours old at examinotiun to indicate reliable results. Please
send new sample.
Ej. Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
- ONLY IF WATER IS AN INDIVIDUAL SUPPLY -
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED /
Sample Collected From ❑ Kitchen Tap ❑ Bathroom Tap ❑ Basement Tap.
❑ Other (List) ---
Well — 0 Dug ❑ Driven ❑ Drilled ❑ Bored _
SOURCE: O Sprang ❑ Cistern ❑ Other—
Dug Well or Cistern Construction:
Walls —❑ Wood ❑ Concrete ❑ Metal ❑ Tile Brick or
Top — ❑ Wood ❑ Concrete ❑ Metal ❑ Open Top ❑ Concrete
LOCATION: -
❑ In Basement ❑ Basement Offset ❑ Under House
❑In Yard ❑ Other
Building Sewer Septic
DISTANCE TO: or Other Drainage Pipe Feet. Tank Feet.
Tile Seepage Cess -
Field Feet. Pit Feet, Pool Feet. Privy Feet.
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- ❑ Cast Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos
❑ Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No
When? —
Diameter of Well Depth Feet
Well Casing
Material Diameter Depth
Length of Water Depth
Drop Pipe From Bottom Feet.
PUMP LOCATION: In Well Bafsement in In Utility
❑ ❑ ❑ In Basement ❑ Room
On Top
❑ Of Well ❑Other
PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No
New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature
06-1220 (b) BACTERIOLOGICAL WATER
Rev. 1973
r
ANALYSIS RECORD
READ INSTRUCTIONSDate Received Time Received
am
pm Lab. No.
r
Lactose Broth 70,c locc
Iocc IOcc locc 1.Occ l.Occ
ON 24 Hours
48 Hours
Brilliant Green
REVERSE SIDE 24 Hours
48 Hours
EMB
AGAR
BEFORE Lactose Broth, 24 hrs. 48 hrs..
Gram's stain
Coliform Density _
(Most probable No. per 100cc)
MF Results
COLLECTING SAMPLE
Reported by
-
Date a.m.
P.m.
This analysis indicates Coliform Organisms to be:
Absent -
Present
GREATER ANCHORAGE ARc.;, BOROUGH
Department of Environmental Quality
.` 3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMP.O VA i FHA _ _ CONV y�
2. Property Owner:
Nailing Address:
n Day Phone L/
3. Name of Buyer:
Mailing Address:
4. Name of Lending Institution: _/47-
Mailing Address: ,376 (:�. 1,1,-3. ��c.�r�ePhone Qi9 -tel Z-7
5. Name of Realtor or Agent
Mailing Address: Phone
6. Legal Description:L5 Bl--��a(e,���� _
Location: �i)L�// �_'Ca�T
7. Type of Facility to be inspected: �(� Na. `Bdrms _
8. Water Supply
Type of Supply: Public Utility _ Individual
If Individual, number of dwellings presently served I
If Individual, depth of well
9. Sewag.� Disposal Systen
Type of System: Public Utility individual (on-site) 1/
If Individual, date of installation
Ju�.�
February 26, 1975
Alaska 5tatebank
314 E. Northern nights
Anchorage, AK 99503
SUBJECT: Sewer and Nater on Lot 5, Block. l Talus West.
Dear Ms. Plickey,
This department has completed a request for approval of the
sewer and water facilities on Lot 5, Block. 11 Talus West Sub-
division.
The water analysis has been raturned, and is satisfactory.
The sewer system for this lot was installed and approved in
August 1974, for a three bedroom single .family dwelling.
Your peyuest for approval is for a four bedroom house. This
Department can grant approval of this sewer system for a three
bedroom house only.
If you should have any questions concerning this utter, please
contact this office at 274-4561:
Sincerely,
Denise , C. Bashaw
Environmental Control Officer II
ACES/sr
)artment of Environmental Qualit..
Water and Sewer Questionnaire
�y
Date Time
Subdivision %v/1- "-(r , Block_, Lot
Owner's Name:
Mailing Address:P�J(
Questions:
1. How many bedrooms are now in your house? 4
2. How many bedrooms were in the house at the time of purchase?
3. Were the basement bedroom walls "roughed in" at the time of purchase?
4. Was the basement bathroom plumbing "roughed in" at the time of T�—
purchase? - f_
5. Did the realtor or builder inform you that you would have to enlarge the
existing sewer system if you finished the basement bedroom (s)? It.119
6. If on a publi water supply, do you always have an adequate supply of
water? N�%
7. Is the pressure always adequate?A�1,4
8. Who was the builder?
9. Who was the home purchased from? ���✓ /r
OTHER COMMENTS:
n .+
J
c�G✓/✓�i✓ Lv,.� �-e cLr y -- Y� .�v. % 9�e.-f i- ? f 4,✓e- �.vr-�.� --,�.•_.
S S,.r.G7'¢� cT .,.� J r t Gv-✓',r..�_d N -�/� w TC. J
w' partment of Environmental Quali+
" l �--/Water and Sewer Questionnaire `-)
Date Time
r
Subdivision�<,�_4/-rr , Block_, Lot
Owner's Name: X2%. r '/ // 2 4
Mailing Address:
Questions:
1. How many bedrooms are now in your house?
2. How many bedrooms were in the house at the time of purchase? 4
3. Were the basement bedroom walls "roughed in" at the time of purchase?
4. Was the basement bathroom plumbing "roughed in" at the time of
purchase?yQ S
5. Did the realtor or builder inform you that you would have to enlarge the
existing sewer system if you finished the basement bedroom (s)? xc)/p
6. If on a public water supply, do you always have an adequate supply of
water? N W
7. Is the pressure always adequate?/�,//q
8. Who was the builder?
9. Who was the home purchased from?
OTHER COMMENTS:
'0 h n_, t fl Jam, ur J,. rre. �. F'a,..._�..-, d • //, - r i t ��• e -G
.' F ��! /I'«7 ✓, r..' cf F /k_ � n: P- : i.✓ 7h <_ .f-,�e E% '%� s��`
J
DGVi✓e� re- �f yZ - /� �,<%
7-t�.r7-
wQf i,��•:�r��=,r
rr 0cr
e,r
OJT-'FlowNy ws C> -r
Jo , ,6'/, .'.