HomeMy WebLinkAboutT15N R1W SEC 9 Lot 24A
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
ME
LEGAL DESCRIPTION
LOCATION ~'OT'
DISTANCE TO: I Well
iAILING ADDRESS
Manufacturer
DISTANCE TO:
No. of lines
IF HOMEMADE:
Well
Well
Length of each line
Top of tile to finish grade
DISTANCE TO:
Width I
Crib diameter
Depth~
Building foundation
IAbsorption ar~_¢~ I~/,
Inside length
f~ndation
al length of lines
~V/~terial beneath tile
PRONE /~NEW
E]UPGRADE
Dwelling 13
Material
Nearest lot line
Trench width
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
inches
Total effective absorption area
inches
Total ef fective absorption area ~,~0~) ~
Nearest lot line ~'~ I~
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
OTHER
PiPE MATERIALSp VC
SOIL TEST RATING /~O¢j~/¢__/
REMARKS
'To
APP~ D
72-~3/Rev. 3/781
DATE LEGAL
/ /
ermit ~
~ICIPALITY OF ANCHORAGE
Dep~rtme~t o~ Health and Environmental
otection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
~plicant: ~ S ~ Mailing Address:
~.qcation:
,egal Description: L
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms:
Phone Number:
Lot Size:
Seepage Bed: t--~ Holding Tank:
Soil Rating(sq.ft/br) /S~
The Required Size of the Soil Absorption System Is:
DEPTH, ~-~' LENGTH ~ ~ GRAVEL DEPTH ~o" 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 pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /dO ~ 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 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3)
Signe~:
and wells as
I understand that the on-site sewer
the~esidence ~/~eled to
A-~cq~. ,/I/~Z.~
Applicant '"-~'
system may require enlargement
include more that 3 b~ooms.
Issued by: ~ ~
Date: ~//~k~ / ~
if
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
/~ SOILS LOG
[] PERCOLATION
TEST
DATE PERFORMED:
3
L.I&W'~' 51bT
5
6
8
9
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
TEST RUN BET~/EEN
~f'/~ (minutes/inch)
FT AND -- FT
PERFORMED BY: ~B 19BX
72-008 (6/79)
OOC Co.
SULLIVAN WATER WELLS
P.O. BO)~272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
~ Il
O~NEROFLAND~n'"JO Y ~,.',r~,~,~'_,4q ~ D~,T. OFWm I 6o ~
LEGAL DESCRIPTION
PERMIT NUMBER
DRAW DOWN FT.
GALS, PER HR __.~& 0I~O
KIND OF FORMATION:
From 0 Ft. to.--~--Ft, ~')~'~ ~'~'"J~
From ~ Ft. to .~C Ft. ~"t~'~ ' ._
From Ft. to Ft. ~'~" ~"1 ~' ~'~-
From Ft. to FI
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft..
From Ft, to Ft
Frmn ..... Ft. to ..... Ft,
~ ~,~C ~.. From .... Fi. to
~ ~'fflf~ From_ Ft. to ...... Ft.
From Ft to . Ft
Fron~ Ft. Io FI
From Ft. to .Ft
From __ Ft. to Ft..
From Ft. to _Ft
From Ft. to ~Ft
;[;From= . Ft. to _Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From ........ Ft, to _. Ft
From .... Ft. to ..... Ft.
From _Ft. to_ Ft.
From Ft. to Ft.
From ..... Ft. to _Ft.
From .......... Ft. to Ft.
a M1SCL. INFORMATION:
DRILLER'S NAME -, -
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION
DIVISION OF ENVIRONMENTAL HEAL'FH
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ,-
1. GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name //,/UZ)f~ ,/'~_z3Z~Z/'2 Telephone: Home Business
Applicant Address /~'~' ~'O~ ~.~ ~. ~
(c) Applicant is (check one): Lending Institution []; Owner/builde Buyer []; Other [] (explain);
(d) Lending nsttutonJ~'/~,~/,,/~/j ,~¢*'87-~'-~-' Telephone
Address ~ ~,
(e) Real Estate Company and Agent ~ ~ ~
Address
Telephone
(f) Mail the HAA to the following address:
17034 Eagle Rl~er Loop Road No, 204
Eagle River, Alaaka 99577
TYPE OF RESIDENCE
Single-Family~ Multi-Family%:~ []
Number of Bedrooms ~
Other
WATER SUPPLY
Well~ Community [] Public []
Individual
Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsitex 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.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIr., ~ INSPECTIONS, TESTS, FILE SEARCH, ~..rA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
S & $ ENGINEERING
Address ~ 7034 E-'C!' ['!"~" [ '"%" ~-~-'~ H=. 204
Date Eagle River, Alaska 99577
Telephone
/ /
DHEP APPROVAL
Approved for ~'~"~"~'"~ bedrooms By ~
Approved ~ Disapproved
'~"~"~'~ Date
Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
Mb*,,CIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (NAA) JUN 81987
CHECKLIST- FEBRUARY 1984
264-4744
Legal Description: L o F P~ [~,~/~-~Jd-,V~E,/J~,~
WELL DATA
Well Classification
Well Log Present~N)
Total Depth /f~,~
Static Water Level
Cased to
Casing Height Above Ground
Electrical Wiring in Condui (Y~)
Separation Distances from Well:
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ ~,¢ ,E~ Yield
/,'-'~ Depth of Grouting
/~ Pump Set At
.~c," Sanitary Seal on CasingS/N)
Depression Around Wellhead (YN~
To Septic/Holding Tank on Lot //~:/ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot //.'-~'~ On Adjoining Lots
To Nearest Public Sewer Line /'""/.'q To i~learest Public Sewer
Cleanout/Manhole ~/,'~ To Nearest Sewer Service Line on
Water Sample Collected by ~ .¢-,~ ~.,,./~/.,,./¢=~_..-¢~1,.,zc. ; Date
WaterSampleTestResults ..~',;¢~ ~'~/.,~l~¢"r'ol'z.~. ~-o ~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes(~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/.N~!
~//4
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
~) ' ~- - P~$ Size / g--Co No. of Compartments
Air-tight Caps ~_~N) Foundation Cleanout~N)
Date Last Pumped ,~- - Z. ~ -,~ ~.
;for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course /~'//~
To Building Foundation / --~
To Disposal Field ~'
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026 fRev 81861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ 'Z~-
Width of Field
Square Feet of Absorption Area ~
Depression over Field (~/~ ,~'/~-~
Results of Last Adequacy Test ,~.,~-~-/,¢,¢",,,¢¢.4~'¢~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~"~f"~ cz/ .~'/'~=,.,~ ,~c/~'
Type of System Design
Length of Field ~
Depth of Field ~- '
Gravel Bed Thickness / '
Standpipes Present~..~/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots .~¢5
~/T~,/~utbank (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)
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 I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed $ & ~, .%%,G I ,~; .~ _~ = l,~;C Date
Company 17034 Eagle River L~ Red ~8~o.
Eagle Rlver~ Alaska 995~
Receipt No, ~ ~O /-
Date of Payment ~ ' ~ ' ~ ¢
Amount: $ ~O ~
Page 2 of 2
72 026 trey 81861 Sack
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
~.~" X 5633 S STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~,~
:~;an}p i e ~'ec' ct : OON Z ~ ;'
iJcdered ~y : Ui,5[HOWf~
L/Ob4 6aG]:i: J~fVER LO0? RB,. ~204
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
H86-i400
AMENDED
Application Date 12-19-86
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legat Description (include lot, block, subdivision, section, township, range)
Lot 24A, Section 9, T15N, R1W, S.M.
Location (address or directions)
Property Owner RAndy ¢,m~neau Telephone: Home 688-4423 Business
Mailing Address P- ~- Rr~x R7f}90/, Chuglak_. Alaska
Lending Institution Northland Mortma~e Telephone
Mailing Address Eagle River. Alaska
Real Estate Company and Agent _ Linda Ballard/Greatland
Address P.O. Box 633. Eagle River. Alaska
Telephone 694-9125
~cthe HAA to the followinc~ address: or: Check here [~X, if hold for pick up. ontact person and day phone number below,
(b)
(c)
(d)
(e)
TYPE OF RESIDENCE
Sing[e-Family ~
Number of Bedrooms
WATER SUPPLY
Individual Well I~ Community [] Public []
Note: Jf corn m unity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note; If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 IRev 8/86) Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Telephone
Address
Date
ENGINEER'S ORIGINAL STAMP AND
SIGNATURE ON FILE WITH DHHS
Engineer's Seal
DHHS APPROVAL
~pc~al ~-wn(?) bedrooms by '~ ~cu-~' Date March 25. 1987
Approved Disapproved Conditional 'XX'X
Terms of Conditional Approval Existing system must be upgraded bv June 15, 1987.
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2 72-025 fRev 8/861 Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL /~/~/~ ~ ! L/~_~
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~D'//~/
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b)
(c)
(d)
(e)
(f)
Applicant Na~lephone: Home _/~_~ - '/-'/5/,=;- ~ Business
/ ' /
Appl~t iS (check one~ Lending institution D; Owner/builder ~; Buyer~; Other~ (exp ain);
Lendi~olnstitution~~ ~'¢~-, Telephone ~
~he HAA to the following address:
TYPE OF RESIDENCE
Single-Familyx Multi-Family []
Number of Bedrooms
Other
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.
4. 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.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~A AND INFORMATION
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspect[on, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm C J~ ¢
Address ~g R 1._~6.~''
Date EAGLE RIVER; AK
Telephone
/
6. DHEP APPROVAL
Approved for '~- ' ~ bedrooms by
Approved .~ ~ ~ Disapproved
Terms of Conditional Approval
T~ o~ THE P~/~
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (~
O%~,~UNICIPALITY OF ANCHORAGE (MOA)
, h~ , ~. I-I~F~LTH AUTHORITY APPROVAL (HAA)
,~ ~O~TO~C~'\u' CHECKLIST- FEBRUARY 1984
~.~1\~3''' ~l,Ob'~'~ Legal Description:
WELL DATA-¢'(" . I~.,,~.C~.~,,.'~
Well Classification ~,~, If A, B, C, D.E.C. Approved (Y/N)
Well Log Present(~N) Date Completed ~:'-~ ~ ~"~ Yield
Total Depth linc)' ~5" Cased to
Static Water Level I~f'"~
Casing Height Above Ground
Eledtrical;Wiring in Conduit~N)
Separation Distances from Well:
To Septic/J:~d~r'g Tank on Lot
Depth of Grouting ' ' -
Pump Set At 01~
Sanitary Seal on Casing,~N)
Depression Around Wellhead (Y/~)
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot \ ~ .~ i ; On Adjoining Lots
To Nearest Public Sewer Line '51~' To Nearest Public Sewer
Cleanout/Manhole P/~' To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~ ~-~ ~C:~G (r~-,~ll,--..~ ; Date ~"~' ~ ?~'/~
Wa.t.e~ampie Test Results ~"I~'~
B. SEPTIC/I-I&N~NNG TANK DATA
Date Installed "~-~?.~"5 Size
Standpipes~)N) Air-tight Caps ~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N) j
Holding Tank High-Water Alarm (Y/N) I~/,~
No. of Compartments
Foundation Cleanout t~N)
Date Last Pumped
;for -
Temporary Holding Tank Permit (Y/N) h.5/~ __
Separation Distances from Septic/~g Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line,
Course
Comments
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
72~025 (Bev, 3/9 Back MOA 2
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~A AND INFORMATION
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspect[on, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ¢ J~ ¢
Address ~g R 1._~6.~''
Date EAGLE RIVER; AK
Telephone
/
6. DHEP APPROVAL
Approved for '~- ' ~ bedrooms by
Approved .~ ~ ~ Disapproved
Terms of Conditional Approval
T~ o~ THE P~/~
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed -"/
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/4~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
Type of System Design
Length of Field ,~.~
Depth of Field ~-~
Gravel Bed Thickness I
Standpipes Present ~N)
Date of Last Adequacy Test
To Water-Supply Well
To Building Foundation ¢,/J~
Lot
To Water Main/Service Line ~ ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots '"&c:> I..~
To Cu~tbank (if present)
,12
D, LIFT STATION
Date installed Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
High Water Alarm Level at
Tested for
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signeds & S ENGINEERING
Date
SRB 196X
MOA No.
C°mPaI'~GLE RIVER, AK
Receipt No. ~1/2'~1~
Date of Payment
Amo.nt:$
Page 2 of 2
72-026 (11/84)