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Home My WebLink AboutMCMAHON BLK 2 LT 20 h, a 03 20 10:59a .-,n,horaye'Nell & Pump Ser X072430742 F,, ��'�". "!eL A.�C2. �i4 JL=�� 7'.�:�:� �yv:'�i:.fi..�.•.i' ��i Well Drilling Permit `itimbe.r: Parcel Idc"tific:ttion Number: C7 /7 2 Legal Description Date of issue. Property Owner Name & Address: S 1 -v--o rV-0 Puml? Installation 1Ctate: Purnp Intake ]depth Below Top of Well C4.,sono: jS�feet Pump Manu racturer's :lane: A Y Pump Model: d v I Pump Sire fop Fitless Adapter Burial .D elitL: j feet Pitless Adapter h4anjtfacturer'5,Natne: Pi#less Aidupter [nstaller: �� A `►'Veil Disinfected Upolr ►. ompletiou? [RYes ❑ No Method of Disinfecrir,a: Comstients: PUMP lustaller Pante: Attention. The. puirQ i shall provide s run:F installation iog ti, the. DSD ��ithin 3ojays ai purr,» insiwilation. men r(,�.uiF' ful �b) rt !ii ��-�i Nr:.�Ai•��YY• y�til 1G..3 iiJl', �anrid 47W�0 Err 11s3r k Beyl:I7 1'ByCf !, .zi1'•rf10('C�?, :3- ��"' E A F r_!�,,t• Pump Installation Log Well Drilling Permit `itimbe.r: Parcel Idc"tific:ttion Number: C7 /7 2 Legal Description Date of issue. Property Owner Name & Address: S 1 -v--o rV-0 Puml? Installation 1Ctate: Purnp Intake ]depth Below Top of Well C4.,sono: jS�feet Pump Manu racturer's :lane: A Y Pump Model: d v I Pump Sire fop Fitless Adapter Burial .D elitL: j feet Pitless Adapter h4anjtfacturer'5,Natne: Pi#less Aidupter [nstaller: �� A `►'Veil Disinfected Upolr ►. ompletiou? [RYes ❑ No Method of Disinfecrir,a: Comstients: PUMP lustaller Pante: Attention. The. puirQ i shall provide s run:F installation iog ti, the. DSD ��ithin 3ojays ai purr,» insiwilation. Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE ^ FROM WELL,~]/'''g~:2 INSIDE LENGTH INSIDE WIDTH ~ LIQUID DEPTH ~ LIQUID CAPACITY. / ~z~ GALLONS. SEEPAGE PIT: NUMBEROFPITS /. DIAMETER OR WIDTH__ LENGTH.~,/DEPTH /~ )~- LINING MATERIAL . CRIB SIZE: DIAMETER__.DEPTH DISTANCE FROM: WELL //z~ fTC. TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION __ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED . DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK .__ SYSTEM INSTALLED BY: ~'~)~'B ~_. REMARKS: DIAGRAM OF SYSTEM PERMIT NO. r-llJ~ I E: I ~'RL I T'T' OF F~Nw3HO~:i::IGE DEPARTMENT OF' HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORRG6 AK. 9950? 276-222i ~4ELL ~ 76i51 > OF~--$ I TE SEI.-JEF.' PERr'I I T APPLICANT LOCATION LEGAL CHARLES P MILEWS.K~ FURROW CREEl( RD L20 B2 MCMAHON SUBD i601 "F" ST LOT SIZE 272-8076 29500 SQUARE FEET TYPE OF SOIL 8BSORBTION S~'STEM IS: TRENCH MR;-':: I MUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION S~STEM IS: [:,EF' T'H= i2 LEI'-.IGTH= _"Z--8 (]iR R'-.-' E L [:., F P TII I~:~ 5 THE LENGTH DIMENSION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRRINFIELD. 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 OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. ~:Ew2U I RED SEPT I C: TRNI< S I ZE= iO00 GRLLr]F~'i; BACKFILLING OF AN~ SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL B~ THI:q DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN 8 NELL AND ANY ON-SITE SEWAGE DISPOSAL S~STEM IS i00 FEET FOR A PRIVATE NELL OR 200 FEET FOR 8 PUBLIC WELL. NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF 'THE NELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FOR O[~E 'T"ERR FROt~ I SSLIE I CERTIFY THAT i: IRM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALIT~ OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS, APPLICANT CHARLES P MILENSKI · ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 9950? 2"76-2221 ~dEL~ 8~gC, 0~4--S I TF SF~dER PERP1 I T PERMIT NO. ( 7~1~ ) APPLICANT LOCATION LEGAL U_ RLES ILEWSK FURROW CREEK RD L20 B2 MCMRHON SUBD iGOl "F" ST LOT SIZE 272-8076 ~9500 SQUARE FEET TYF'E OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RR'FING (S~! FT/BR>= t58 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L',- EPTH= :1L0 LENGTH= 57 GRAVEl THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE THE DEPTH OF A TRENCH OR PIT IS THE DI ICE GROUND AND THE BOTTOM OF THE EXCAVATI~ THERE IS NO SET WIDTH FOR :HES. THE GRAVEL DEPTH IS THE AND THE BOTTOM OF THE DRAINFIELD. OF THE TFRLL PIPE REL-~IIj I RFD SF, PTI C T,'~,I I .'ZF: ~.000 i]AL LOi'-i$ BRCKFILLING 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 i00 FEET FOR 8 PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. F'EI~;r-I I T VAI,, ,, I D FOR ONE YEAR FROM ! SSUE I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER S~STEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. C~ ~ ~ ~r~ ~.'t V , s i G.ED:_ .... RPPLICRNT CHARLES MILEWSKI PERMIT NO. MLI[-t I C: I.~RL I T~' OF ' FtNCF'-'!R DEPARTMENT ~'HERLTH AND ENVIRONMENTAL 'OTECTION 2510 E. /UDOR RD., ANCHORAGE, AK. 276-222i &-JELL AF~D ON--SITE 5E~4EF: F'E~:f-1 IT APPLICANT LOCATION LEGAL CHARLES MILEWSKI FURROW CREEK RD L20 B2 MCMAHON SUBD T SIZE 272-8076 29500 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH HRXIMLIM NUMBER OF BEDROOMS = 4 SOIL (SQ FT/BR)= i50 THE REQUIRED =,I,.E OF THE SOIL ABSORPTION --,Y~ IS: ~--'EF'TH= '10 LENGTH= \ RVEL DEPTH= 'THE LENGTH DIMENSION IS THE LENG; OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS ;TANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAY~ (IN FEET>. THERE IS NO SET WIDTH FOR THE GRAVEL DEPTH IS THE MINIMUM 'H OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAYATI IN FEET>. RE~__U I F~ED SEF'T I C $ I ZE: 1250 GALLF~N --S BACKFILLING OF ANY SYSTEM NIl DEPARTMENT WILL BE SUBJECT FINRL INSPECTION AND APPROVAL BY THIS ;UTION. MINIMUM DISTANCE BETWEEN A i00 FEET FOR A PRIVATE NELL LOGS ARE REQUIRED OF THE WELL COMPLETION. SPECIFICATIONS INSTALLATION. AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS FEET FOR R PUBLIC WELL. BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS DIAGRAMS ARE AVAILABLE TO INSURE PROPER F'ERM I T ~! O1'-,1~ '-r'F, ,qR FROH;~ ISSUE I CERTIFY THAT i: I AM FRMIL WITH :NTS FOR ON-SITE SEWERS 8ND WELLS AS SET FORTH BY THE ICIPALI' ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE~i! ~; I UNDERSTAND iTHAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: ...... ~ APPLICANT~, CHARLES MILEWSKI ISSUED BY. ._DATE ..... CONSULTANTS, INC. 249 EAST 51ST AVENUE P,O, BOX 6087 ' ANCHORAGE, ALASXA 99503 * ']'FLE[PHONE 907-279-0483 ANCHORAGE FAIRBANKS JUNEAU TELEX 090-35419 May 6, 1976 R&MNo. 656221 Mr. Charles Milewski 1601 F Street Anchorage, Alaska RE: Test Hole and Soil Log Report of Sanitary System Lot 20 Block 2 McMahon Subdivision Dear Mr. Milewski: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of May 6, 1976 nad those procedures outlined in a letter dated July 15, 1976, by Mr. Rolf St~ickland of the Municipality of Anchorage, Department of Environmental Quality. A single-test hole was put down within the Lot 20 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted bachoe and t~e test hole was extended to a total depth oral6.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to he of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. JWR/WED/pe xc: Municipality of Anchorage MuNiCiPALiTY Oi: ANCHOP, A.GE D~.PT. OF H£At~H & ENVIP, ONMf-NTAL pRoTECtION, RF.c iV F-D TH 1 · ~ SILT, TRACE SAND (ML) ~ 1 ~. '.'.~ i .2 ," GRAVELLY SAND "'/'"' TRACE SILT (SW) No Scale ~ SILT, TRACE SAND {M~) 16.0 T.D. No Water Table DWN: VRZ ~ V F.B. ~ M Log of Test Hole SRID:' CKD: WED 0A~: 5-25-7~ ~ ·Charles Milewski ~ROJ. NO. 656221 Alaska SCALE: 1"=3' ~ DWG, NO. A-O1 249 EAST SIST AVENUE CONSULTANTS, INC. P,O, BOX 6087 ANCHORAGE, ALASKA 99503 · TELEPHONE 907-279-0483 ANCHORAGE FAIRBANKS JUNEAU TELEX 090-35419 April 22, 1976 R & M No. 656221 Mr. Charles Milewski 1601 F Street Anchorage, Alaska Re: Test Hole and S0il Log Report for Sanitary System Lot 20 Block 2 McMahon Subdivision : Dear Mr. Milewski: We are submitting herewith t~e test boring and percolation results along with the commen~s regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of April 22, 1976 and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Municipality of Anchorage, Department of Environmental Quality. A single test hole was put down within the Lot 20 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 20.0 feet below ground surface. The final log prepared for the test hole has been in- cluded in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity of be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very t~uty yours, ~~R & M CONUSLTANTS, INC. James W. Rooney~~ Vice President JWR/pe xc: Municipality of Anchorage T.H.1 4-22-76 ORGANIC MATERIAL (Peat) 1.5' H UFFbL~N ROAD no scale SILTY SANDY GRAVEL Occasional Cobble (G:,~) / SAND, TRACE SILT ./~ ~ Tan (SP) ~ b 9.0' SAND, SOME SILT TRACE GRAVEL (SM) No Water Table 20.0' ToD. Log represents location of test hole Lot 20 Block 2 McMahon Subdivision V/~2L ~ ~ Charles Milewski ProDertv CKD: WED ~ M Log of Test Hole '~ - GRID: DATE:4-22-76 ~ ~ A Anchorage, Alaska PROJ. NO. 656221 SCALE: 1"=3' ~I&M I::ONSULT.AN?~J, ~ N ~- DWG. NO. A-01 PERCOLATION TEST Charles 5~lewski R & M No. 656221 TIME 1:00 1:0I 1:02 1:03 1:04 1:05 1:10 1:15 1:20 1:25 1:30 1:35 1:40 1:45 1:50 1:55 2:00 ELAPSED TIME 0 1 1 1 1 1 5 5 5 5 5 5 5 5 5 5 5 60 ~nutes DROP INCHES 0 1 1/2 1/2 1 1 2 3 I 1/2 i 1/2 2 1 1/2 i 1/2 I 1/2 2 2 2 24 1/2 inches Total Drop :~.f LOG OF TEST BORING Date Begun /~}~;':'i~~. (,/~ RS~M Hole No. CONSULTANTS Sheet of ' ' Date Completed INC. Total Depth Rig No. ANCHCRAG E FAIRBANKS ~ JU~AU Project No.. ALASKA Project Nome Ground Wot~r Teb[e -'~.,~ ~ '~ ~ Time Field Party Geologist ' ~' , ..... Date Weather Sampling DESCRIPTION Location Notes ~ Diagram= Soil type, color, texture, ~ ; estimated p~rticlesize, ~~ ~ J~, ~ ~ sampler driving notes, d ~ ~ ~ c ~ o depths circulation lost, Traffic. Ditch. ~ ~ ~ c~ ¢ ~ ~ o e ~ notes on drilling eose, J u - m 'G -~ ~ Vege'~ation: 0 o .. 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) ~NAHo~ ~--~. L.o~r .~ ~, ~c~ ~ Location (address or directions) (b) Property Owner ~'~t~¢L~S~qiL~J%~'~f/--'l Telephone: Home ~'5~7 Business Mailing Address ~i'~ ~-~ ,Z~C~r~' (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the followina address: or; Check here/~ if hold for pick up. List contact person and day phone number below. - 7 TYPE OF RESIDENCE Single-Family'~ Number of Bedrooms WATER SUPPLY ~ Individual Well~ Community [] 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 I-I Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 fRev 8/86~ Front '~JOM S,Je@U!bU8 IBUO!SSeJOJd eqi U! sue!ss!u JO JO SJOJJe JOJ elq!suodseJ leu s! eeBJOqOUV Jo/,~ilBd!o!unhl eq/'penss! s! a~Bo!j!lJeo B eJoJeq e~Bp eZ/,IBUB JO suo!~oedsu! ]~onpuoo ~,ou op SHHQ jo sae,~oldLU:l 'siueuueJinbeJ eJB~S pUB IB~ep@j u! suo!jnj!lsu! 6u!puel J!eqi pUB SaLuoq JO sJasBqoJnd o~,~sapnoe B sB s!qi seep SHHQ eqJ. 'B~sBIv JO elBJS @qJ u! peJejs!6eJ Jeeu!bue leUO!SSeloJd luepuedepu! UB ,~q e^oqe S qdeJi~BJBd U! UeA!8 suo!lejueseJdeJ @q~, uodn ~lUO pesBq le^oJddv ,q!Joqjnv q~,leaH sanss! (SHHQ) seo!AJas ueuunH pub q~lBaH Jo lueLu~BdaQ eeBJoqouv NOI.Ln¥O IBUO!l!puoC) IB^oJddv lebO!j!puoo jo suJJeL pa^oJddBsiC] --~ peAoJddV Xq suJooJpeq ('¢2 ¢~'¢'~/ Jo~ paAoJddv lVAOt:tdd¥ SHHO '9 .g MUNICIPALITY OF ANCHORAGE F. NVIRONMENTAL SERVICES DIVISION MAR 2 ? 1987 RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: Well Classification Well Log Present (Y/N) Total Depth 17 Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot -'t"/tO0 To Nearest Edge of Absorption Field on Lot '~14z-/~ To Nearest Public Sewer Line ,Jr~' if A, B, C, D.E.C. Approved (Y/N) I.d~.~J.. ~o~-= 900 ~'¢-~ Date Completed '"7/~/.,¢-~, Yield 'ri4c~'T(~T ~ _?o~l~Ph', +~o' WSuAI-~-"/~ Cased to ~/'~.~-IF-i~'~ Depth of Grouting ~'~¢ Pump Set At U~ 1~'//-/- Sanitary Seal on Casing (Y/N) V~'~ ""/~"~ Depression Around Wellhead (Y/N) NO ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer +tOO Cleanout/Manhole Jr [OO To Nearest Sewer Service Line on Lot Water Sample Collected by ¢~L .~5,/~tJ/dP~¢.~ ; Date ~/'~(~/~'~ ~'~ Water Sample Test Results ~'~/~.-~/~O¢.~(" ~ Comments ~L¢--.~.~' ¢~'T~CJ.J~-I'~ !jJ~¢..~.~ I ~L)~;~'~"r-~-~T ~'/~ ~/~ SEPTIC/HOLDING TANK DATA Standpipes (Y/N) V Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '~l To Property Line To Water Main/Service Line Course .Jr { ~(..~ Size /OO~ Air-tight Caps (Y/N) NO No. of Compartments "~:~ Foundation Cleanout (Y/N) Date Last Pumped [0 ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field (~/ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 fRev 8/86~ Fron! C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well '~' (O0 / To Building Foundation "~-~( Lot -k lO Type of System Design Length of Field ~-~'/ Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ~lO ; On Adjoining Lots To Water Main/Service Line -I- ¢~';'~ / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course -~0 ! To Driveway, Parking Area, or Vehicle Storage Area Comments LIFT STATION ["-i/.//~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at ~,, / Tested for Electrical Codes (Y/N) ,,. / Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that H~ave checked, verified, or conformed to all MOA an~ HAA guidelines in effect on Signed ~._).~1~ .~.A ~ Date Receipt No. ~- Date of Payment ~ --~ % E ¢ Amount: $ / ~2 ¢ the date of this inspection. Page 2 of 2 72-026 fRev 8/861 Back P.O. BOX 112688 "~ ~ ~¢~,~e4 CLEANING SERVICE PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688 Job Address OATEy I ,'i T;ALESMAN ~, t; I TE:MS-30DA~Y~/'~ /"'-~,,: ~'. ! ~, ~ '" ' '"' ' I ; .... : ":-~'"' ROTOR ROOTER SERVICE CALL HRS. STEAM THAWING HRS. TRIP CHARGE HRS. OVERTIME CHARGE HRS. ADDITIONAL LABOR CHARGE HRS. (~. PUMPING SERVICE (GAL) HRS H'RS HYDRO-JET SERVICE MATERIALS PLEASE PAY FROM THIS INVOIC~/ '~' CUSTOMER ORDER # TOTAL "~ ' '~ '/ TOTAL FOOTAGE CLEANED OR THAWED· BLADES USED PROBABLE CAUSE OF STOPPAGE ,..~' / ~ / ~.-~..~ , , ~, .:,) . J , , . ,, ,, .... ..- ....,_%.. /--:? /~- ..:- LINE CLEANED [] JOB NOT GUARANTEED FOR FOLLOWING REAS. ON WORK ACCEPTED BY,. 1 Location: BESSF., EPPS & POTTS 2220 EAST 88 AV~JE ANCHORAGE, AK 99507 (9O7) 349 ~45~ Subdivision: Block: Client's Name: Address: Tester: Initial Reading o~ Meter: Production Rate: ~.~J GPM' 24-Hour Capacity~0 Galloes