HomeMy WebLinkAboutGREAT DANE PARK LT 3I=
#015-273-48
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Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904P
ON-SITE WASTEWATER INSPECTION REPORT AUC
X020
Permit Number: OSP201092 PID Number: 015-273-48
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
MICHAEL & CHERYL PLUCKER
ABSORPTION FIELD -EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
11031 GREAT DANE CIRCLE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
GREAT_ DANE PARK 3
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area z
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
100'+
--
25'+
TANK ❑ Septic ® S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
ORENCO
Capacity
1500 Gal.
Remarks Tank installed 5'+ to deck supports & 1984 field
resurrected with 2 new driven MTs.
Alarm location
GARAGE
Electrical installed by
MOA INSPECTED
PIPE MATERIAL House to tank 3034 Tank to
PIPE 3034
Installer A+
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspeea;tiontes: V 5/26/20 5/27/20
Location and description
2nd
3`d 8/3/020 4'h
BOTTOM OF SIDING
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval: Date
��Q.��•' ••:tQ,���
.. - .......
" " " " " " "
' . • Curtis Huffman
��
Septic System
Approved
-
(L-SDate �y aozo
�'c'9' •• CE 128991 . O r�
���slF�•. 8/3/2020 .•Ok, ,a
PROFESSI�NA -�
OFESS
Note: this approval does not include well permit requirements.
\ a
trcev voiu/i 1 O)
CO
CO
GREAT DANE CIRCLER =50.00'
L
=85.59'S48° 49' 19"W 68.54'S 6 9 ° 1 7 ' 3 2 "W 8 9 .5 4 'N82° 37' 08"W 105.22'N00° 07' 28"W 309.41'S38° 33' 43"W 403.80'N89° 57' 04"E
36.95
10' UTILITY EASEMENT10'S
L
O
P
E
E
A
SEMENT211.2'25.3'
39.8'18%5%SHED
EXISTING
HOUSE
LOT 4 LOT 3
LOT 2
LOT 1
88.3'
59.5'
1 0 ' U T IL IT Y E A S E M E N T
LOT 4
MH
CO7.4'
3 .5 '8.3'10.9'1 0 .9 '3 0 .4 '35.9'2.7'5.8'
2.7'2.8'
5 .0 '2.1'
6 .3 '2.1'
3 7 .0 '23.2'
1 2 .0 '1.0'
1.0'
1.5'1.5'
EXISTING
HOUSE
LOT 3,
GREAT DANE PARK SUBDIVISION
AS-BUILT
CLEAN OUT
WATER WELL
FENCE
Asphalt
Concrete
Overhang
Wood Deck
LEGEND:
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN
WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH.
DRAWN DATE:
DRAWN BY:
SCALE:
CHECKED BY:
7/27/2020
SC
AP/SC
1" = 50'
PLAT:
WORK ORDER: 20040
83-278
FB/PG: 817/69
GRID: SW2635
REF: 04-L-454
LEGAL DESCRIPTION:
ORDERED BY: BRENT WESTERN
SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE
PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS
SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST
OTHER THAN NOTED.
EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF
ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY
DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR
PLOT-PLAN PURPOSES.
250 H StreetAnchorage, Alaska 99501
Survey Department
Phone 562-5291
Mainline
Phone 243-8985
AECC 668
PARCEL #: 015-273-48-000
#CO
HOUSE DETAIL
SCALE 1" = 20'
ADDRESS: 11031 GREAT
DANE CIR.
MANHOLE MH
5/5/2020
MUNICIPALITY OF ANCHORAGE
Development Services Department one: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICIWELL PERMIT APPLICATION
Parcel I.D. 015-273-48
Property owner(s) MICHAEL & CHERYL PLUCKER Day phone 9077649000
Mailina address 11031 GREAT DANE CIRCLE, ANCHORAGE, AK 99516
Site address 11031 GREAT DANE CIRCLE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) GREAT DANE PARK LOT 3
Legal description (Township, Range & Section)
Lot Size 52,086 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Absorption Field ❑
Septic Tank El
Holding Tank ❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
Initial
❑
Upgrade
0
Renewal
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
t
TYPE OF DWELLING:
Single Family (SF) 0
(w/wo AD U)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance:
I certify that the above information is correct. I further certify that this is; in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: 611 /0-0 aD
Receipt Number: 691161 LI
Permit No. 135P96102
Waiver Fees:
Date of Payment: i
Receipt Number: i
ti.
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
COVID-19:i.:
25% DISCOUNT APPLIED
13030 Sues Way, Anchorage, AK 99516
907-350 -9566 / firstwaterAK@gmail.com
May 1, 2020
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE & RESURRECT ORIGINAL FIELD
LEGAL: GREAT DANE PARK LOT 3
PHYSICAL: 11031 GREAT DANE CIRCLE, ANCHORAGE
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank with lift
station outside any deck supports to serve the existing 4-bedroom residence. The original 1984
will be resurrected and connected. The lot and area are served by private water. The design will
not impact any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201092, Rebecca Carroll, 05/04/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201092, Rebecca Carroll, 05/04/20
Municipality of Anchorage Page of _3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 i Anchorage, Alaska 99519-6650 i Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S W a N o,3o °� PID Number: O L 5�,2% 3- Y 9
Name: V A-1 U 4 N I
Wastewater System: ❑ New P"Upgrade
Address:
l I o
ABSORPTION FIELD
Phone:
No. of Bet dr� oms:
�I
tei/Deep Trench 11 Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
I I
GPD/Sq. Ft.
Lot: Block:
— " Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
t��.cJ✓OLK
-75 Ft.
LS Fl.
Township:
Range: Section:
Fill added above original grade:
Gravel length:
Ft.
Z
3 z— Ft.
WELL: ❑ New ❑ Upgrade
Gravel width:
Number of lines:
(
Distance between lines:
�'
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft.
^CO 0 SD. Ft.
P✓ C -
Driller:
Date Drilled:
Static Water Level:
Installer:
S E
Date installed:
Ft.
Yield:Pump
Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
V
LJ Septic El Holding DYS.T.E.P.
- To
Septic
Absorption
Lilt
Holding
Public/Private
Manufacturer:
Capacity in galloons:
From
Tank
Field
Station
Tank
Sewer Lines
ANc —A
1561_�
Well
1'
l `t
ry
I o2-�
I I "°i
Material:
S
Number of Com artments:
Surface
LIFT STATION
Water
Water
(j N4 ^�^
Lot
Line
�.
a,
Size in gallons:
Manufacturer:
'Foundation
�'�
r.
"Pump on" level at:
"Pump oft" level at:f
High water alarm at:
Curtain
Pum�P, Make & Model
Electrical)` I/lnspec��t,illon�"sperfo"rmed by:
Drain
Remarks:
BENCH MARK
/ � �
Location and Description:
+Gg uDDr-�
&1(4_r
e/
s�
• 9�� t( �. ��r�
eAr
Assumed Elevation:f� q�
l—
EN G I�t�LR'St��4,L
c,
1st
Inspections performed by: —Dates:
2nd 3 7
t ,'b, r.•- <
, • <
Department of Health and u an S r Wes approval
Reviewed and approved by: - ''� I
w.ma rao. 01011 nenn vc
SEP 19 194 08: SIAM ALCAN ELECTRIC 907-562-62-6; $ L n G S A gm -l' x r 'P'2/2ng. x �z
i INSPECTION REPORT:
MUNICIPALITY OF ANCHORAGEo BUILDING SAFETY DIVISION
3500 :EAST TUDOR ROAD
INSPECTIONS (907)�63-3464 INFORHATxON (007)786-9311
■�waza�mrr�.r.ys=vmraerra��$sngfiarwtem--aQarra=Baa=arxw�asF=mgKenmmc=cirr�rww�rates=aa�ta==
NAME: CHRIS w ALCAN 8L5CTRIC PERMIT *; 94-8219
ADDRESS: 11031 GREAT DANE CIRCLE PHONE 4: 563-3787
LOT: 3 BLOCK:' SUED: GREAT 'DANE ( DATE: 4
COMMUgT: DD T'L 02A4-68SO (}
---------------- °, � `'� �m�----------------
TYPE
_-_-----_ ---r-.TYPE OP INSPECTION: ELECTRICAL ROUGH.
0 0
0 0
X11'wY.rwMY YI OYwww wwr_wMlrwwl�4.�111ww w.lYw Y+y_wrry.-1�_rY-./rrrw�wM wNrrr__.�w pr_wrw .M '+
C NO NONCOMPLIANCE OBSERVED C.7 CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW'
I I WILL REEXAMINE AT'NEXT INSPECTION C I DO NOT CONCEAL UNTIL REINSPECTED
COMMENTS: �-
r_r_--ww_+rrr.rTTwr YI YwMr _wr r r +.-------------- MrrrWw.. N�
COMMENTS•
INaPECTO DATE:
�uvu rn�varrtnua aau Mena. PT.FASP. rAY.i. FOR INSPECTION
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or 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.
PRESSURE CALCULATIONS:
Total Discharge at 30' head: 33 gpm
Discharge per 3/16" hole at 5' head: 0.945 gpm
Number of holes: 33/0.945 = 35
Hole Spacing: 32 x12/35 = 11 USE 12 [inches]
Septic System Design
Lot 3 Great Dane
pg•2
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1 25 0 25 15 100 125 150
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SC L E: 1' = 50 FT.
Jle
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3
FT, LONG
FT DEEP
FT, ROCK
1 Well
I
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1500 GAL STEP
I I
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I
Well
I
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00—
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V
1
TOBBEN SPURKLAND P.E.
LOT 3 GRAFT DANE PARK
SEPTIC SYSTEM ASBUILT
203 W 15TH. AVENUE
11031 GREAT DANE CIRCLE
DATE: SEPT 8,
1994
ANCH. AK. 99501(907) 279-3916
JOHN RUDAT
SHEET: 2/3
GRID: 2635
lilmorM
85.
1500 GAL STEP TANK
F, 9
ou
JA
BENCH MARK.
DOOR JAMB.•
f`� w. ,; ASSUMED ELEV. 100.00 FT
ITOBBEN SPURKLAND P.E.LOT 3 GREAT DANE PARK I I SEPTIC SYSTEM ASBUILT
203 W151h Ave 11031 GREAT DANE CIRCLE DATE' SEPT. 8, 1994
A �a— TQ R I I Ak 99501 JOHN RUDAT SHEET- 3/3 GRID: 2635
PAGE 1 OF 1
e
MUNICIPALITY OF ANCHORAGE is)—
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940309
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:RUDAT JUHANI H & JANE H
OWNER ADDRESS:11031 GREAT DANE CIR
ANCHORAGE, AK 99516-1468
PARCEL ID:01527348
LEGAL DESCRIPTION: GREAT DANE PARK LT
LOT SIZE: 52086 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 8/22/94
EXPIRATION DATE: 8/22/95
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
IT IS RECOMMENDED THAT THE TRENCH ON THIS SYSTEM BE A
PRESSURE DISTRIBUTION SYSTEM. HOLE DIAMETER AND SPACING
CALCULATIONS MAY BE SUBMITTED WITH THE ASBUILT INFORMATION
IF THIS ALTERATIONMA i
RECEIVED B
ISSUED BY:
DATE: i 3
DATE: p A-)
T.SPURKLAND P.E.
203 W 15TH. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907)279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 3 GREAT DANE PARK
JOHN RUDAT
No Ground Water or Impervious Layer to 17 ft.
Use Standard Trench
Soil Rating. From test July 22, 194
<1 min/in = 1.2 gal/min
Soil is % sand. See sieve analysis
Required Area per Bedroom:
15011.2 = 125 sq.ft..
Finished Floor Elevation Lowest Floor 100.00
Septic Tank Outlet Elevation more than 8 feet below ground
Use lift station
Ground at new absorption field 98+
Testhole Total Depth 17 ft
Less 6 feet 11
Less 3 ft Cover 8
Rock Depth 8 ft
Number of Bedrooms 4
Length of Trench 4x125/16 = 31.25 ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
32 FT.
TOTAL WIDTH
2 FT.
TOTAL DEPTH
11 FT.
ROCK DEPTH
8 FT.
COVER
3 FT.
STEP Tank
500 gal
Septic System Design
Lot 3 Great Dane
ABANDON EXISTING SYSTEM
VERIFY INTEGRITY OF EXISTING TANK
REPLACE IF NECESSARY
pg-'
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or 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.
u, s
Septic System Design
Lot 3 Great Dane
pg -2
LOT 8 ► LOT 7
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50 0 50 100 150 20,01 250 3WO /
SC /� 1" = 100 FT. '%• We1.. LO 3 1
nor �J C ... 1
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IUBULN �YUKKLANU ['.L.SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE LOT 3 GRAFT DANE PARK
ANCH. AK. 99501 11031 GREAT DANE CIRCLE DATE: JULY 22, 1994
�JOHN RUDAT I I SHEET: 1/3 GRID: 2635
N
--------------
------
25 0 25 75 100
25
SC LEl 1 = 50 FT.
125 150
/
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0v (k)NIH
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Well
z
T�ST LE
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+`+' '` `EXIST.'
S
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SEPTIC
500 G
T K p
STEP
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Well
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Well
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TOBBEN SPURKLAND P.E.
LOT 3
GRAFT DANE PARK
SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE
ANCH. AK. 99501
11031 GREAT DANE CIRCLE(907)
DATE: JULY 27, 1994
279-3916
JOHN RUDAT
SHEET: 2/3 GRID: 2635
32
Monitor 4—inch Perforated
Clean Out
Standard Trenches;
8 Ft c
2'
Wide
32'
L ong
11'
Deep
S'
Sewer rock
3'
Co ver
Clean
-2 T
1-1/4 inch PVC Schedule 40
m
500 Gal STEP
rl nnn„{ / Exist, 1250 gal Septic tank
500 gal STEP
1250 gat, septic tank
TORBEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN
203 W15th Ave LOT 3 GREAT DANE PARK
11031 GREAT DANE CIRCLE DATE: JULY 27, 1994
A �0— TQ�gR Ak 99501 JOHN RUDAT SHEET. 3/3 GRID: 2635
, �RsC?� ir�NeINE€FNS,S�hL?Qi
07
:49-7:1e+
Municipality of Anchorage a
DEPARTMENT OF HEALTH & HUMAN SERVICES cj
825 "L" Street, Anchorage, Alaska 99502-0650 mho 7o brn Spurkland
SOILS LOG — PERCOLATION TEST saa�. CE -2225
PERFORMED FOR: ® Tucctcx. DATE PERFORMED:
LEGAL DESCRIPTION: L_oJf-3 C--1 PCc,.T dC.%I°e Township, Range, Section:
D H
SLOPE SITE PLAN
EET) LOQQ
1
N
2
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? L P
E
Depth to Water After )
Monitoring? v -' Date:
15-
16-
17
5 1617
18-
19-
20-
COMMENTS
81920COMMENTS
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
i
TEST RUN BETWEEN FT AND 7 FT
PERFORMED BY: �'S I �-�=- CERTIFY THAT THIS TEST WASPERFORMEDIN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
w
P.Qr
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
NAMEPHONE_
L I n�
��BB
3�, a Jai 3
NEW
❑ UPGRADE
MAI LING ADDRESS q
PO tt5u 1
LEGAL DESCRIPTION
Grreo_} Dctine Lo -t 3 B10L-K Sec 2-1 T I2 N P, 3W
LOCATIONO.
Jre(x,_+ f� carr C irc 1e
OF BEDROOMS
U
DISTANCE TO:
Veilno-Irto
Absorption area 7-
t�Z
Dwelling 13840-S60
PERMIT NO.
y
az
wH
Manufacturer
ac
Art ckoo e-
Material
S�—eel
No. of compartments
Z
Liq. capacityILons
(1
IF HOMEMADE:
Inside length
Width
Liquid depth
J CD2
DISTANCE TO:
Well
Dwelling
PERMIT NO,
02<
z<
Manufacturer
Material
Liquid capacity in gallons
w =
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMJT NO.
'-t i_% " S G 0
J W z
F? w
No. of lines
Length of each line
�O j 'L
Total length of lines
-
Trench width
2 inches
Distance between lines
e
G F
p
Top of tile to finish grade
Z — q
Material beneath tile
"8 inches
Total effective absorption area
9060,
LU
0
Length
Width
Depth
PERMIT NO.
< F
a.
w°
Type of crib
Crib diameter
Crib depth
Total effective absorption area
LU y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
A) —
Depth
Driller
Distance to lot line
PERMIT NO.
W
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
fpvC C
SOIL TEST RATING
+ Lt G tj' / b
i 7-
30
.
INSTALLER q + W , � l 2
A
REMARKS
e' insv Iafi-l'o^ tves Plcttecj over-
�renck w�.ereveP IeSS 7-11«n Lf, do -t'
2
.
Cove/-• cj-viire cs w4-ttn,'n
c Ifc� t SP
�ur�� f lONc S'T•
%b
3 z 4 -
APPROVED DATE LEGAL 11
SeGre,j- Z>a.V "'r •3 (3 kc IL- -4�' 2 li. TI7-N 11-3
^
�
PERMIT NO:
DATE ISSUED.-
APPLICANT:
SSUED:
APPLICANT:
ADDRESS:
4�
M LJ P4 I C: I F--4 dcw L- I C3 F= f -W PP C�- " 10 F:Z f-% C3 E:' �
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, A� 99501 p'
264-472O
CONTACT PHONE:
840560
07/11/04
AMC INC.
P.O. BOX 2882
ANCHORAGE9 AK 99509
345-5813
LEGAL DESCRIP: SUBDIVISION: GREAT DANE LOT o. 3 BLOCK: NA
SECTION: 21 TOWNSHIP: 12N RANGE: 3W -
LOT SIZE: 52086 (SQ.FT" OR ACRES)
MAX BEDROOMS: 4
Listed below are theoptions available to you in designing your septic
system. Choose the option that best fits your site.
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
~-__- -~-~.~~~~_~__~~___--~_--_�_���_~~,__�_
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA11 and the State of' Alaska.
2^ I will install the system in accordance, with all MOA codes and, regulations,
and in compliance with the design criteria of this permit.
3. I will adffiere toall MOA and Stateof Alaska requirements for the. set back
distances from any existing well, wastewater disposal system or, public
sewerage system an this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit,
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
' SIGNEDDATE:
APPLICANT: AMC INC
��) L/
ISSUED BY DATE:
FT 9%1Kl� "
�3 F=.n
X7,:dc�][��
DEPTH TO PIPE BOTTOM (FT.)
4 5
5.5
4,5
GRAVEL DEPTH (FT.)
0.5
3,5
TOTAL DEPTH (FT.)
12.0)
6"0
8.0
GRAVEL WIDTH (FT.)
2 5 �
21"0
5.0
GRAVEL LENGTH (FT.)
^��
42.0
63.0
GRAVEL VOLUME (CU. YDS.
28.0
32.6
46,6 .
TANK SIZE (GALS)
15250"0 **
1,250.0 **
1,250,0 **
SOIL RATING (SQ"FT,/BR)
146
146
146
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
~-__- -~-~.~~~~_~__~~___--~_--_�_���_~~,__�_
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA11 and the State of' Alaska.
2^ I will install the system in accordance, with all MOA codes and, regulations,
and in compliance with the design criteria of this permit.
3. I will adffiere toall MOA and Stateof Alaska requirements for the. set back
distances from any existing well, wastewater disposal system or, public
sewerage system an this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit,
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
' SIGNEDDATE:
APPLICANT: AMC INC
��) L/
ISSUED BY DATE:
1
5
2
B
8
9
1
12
13
14
15
1 fi
17
18
19
20
21
22
23
24
25
S®1 LS
PROJECT
CLIENT 611/ SUy
W. 0. 17-46
SHEET_OF
L ®.
TEST HOLE NO.
ELEV. TOP OF HOLE 7� 7. ;- +
DATE -4P
3
4
b
7
IUI -eIZ- I C7vKP"? "A -A) OL
g�wrV sit 1 6f+4vKw`! 5Ayvt, sm, F -Z
Sq�nPL� 1tla. -i�'1Lirr� .
FROWVV
(F.44�
r
. � O't f QTM � � ��•
• ed off grOHMrrro •r
r�, •
i 6- nta
��
` <�t�eJ •O 1 E23 -E
i
P�Ce��w'r"Ir�w R.i�� 1p.7 m,,vut'�S pLr �►v�N
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
17
18
19
20
21
22
23
24
25
n UNWIN SCHEBEN 0 KORYNTA ■ HUETTL .
LOCATION OF WELL (Please complete either to, lb or Ic.)
:1 T) BoroughrSobd,,,vision Lot Block1/4 qt r s
—0
I "I I � r . I, S I : , It !. , I . I F f — of — a f
71,. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address and Area of Well Location
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
Drilling Permit No.
A. D. L. No.
Section No. Township N El Range E [j Meridian
S❑ WE
5. OWNER OF WELL:
Address:
2. WELL LOG Feet Below
Surface
Material Type Top Bottom
4.
WELL DEPTH: (final)
5- DATE OF COMPLETION
6.
_0 -Cable tool EJ Rotary ❑ Driven ❑ Dug
Auger ❑ Jetted C] Bored ❑ Other
j;';—,
;j j i
7.
USE: 0 Domestic E] Public Supply E] industry
Irrigation ❑ Recharge ❑commerical
EJ Test Well ❑Other:
Y.
14. REMARKS:
8.
diam.
diam.
CASING: ❑ Threaded ❑ Welded
in. to ft. Depth Weight lbs./ft.
in. to ft. Depth Stickup_ ft.
9.
FINISH OF WELL:
Type: Diameter:
Slot/Mesh Size: Length
Set between ft. and ft.
Backfilling -- Gravel pack
MUINICIPA-ITY op AM-NORAOU
NLALT I &
ENVIRON 4ENTAL Pi?o -ECTIeN
10.
STATIC WATER LEVEL: ft.
Above or [] Below land surface Date
Equipment used: : "' i I
V❑
16. WATER WELL CONTRACTOR'S CERTIFICATION: —
r15. —Water Temperature —0
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief;
i
Registered Business Nome Contract License Number
Address:
ZSigned :7,',7 Dole: A
Authorized Representative
Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer
11 . PUMPING LEVEL below land surface and YIELD
1 11- 1
ft. after hrs. pumping'- ,� 9 -P.M.
ft. after hrs. pumping g.p.m.
12. GROUTING Well Grouted: Yes F] No
Material: [] Neat Cement ❑ Other:
13, Pump: if available) HP
Length of Drop Pipe ft. capacity 9 -P.M.
0 Subm. E] Jet ❑ Centrifical E] Other
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION: —
r15. —Water Temperature —0
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief;
i
Registered Business Nome Contract License Number
Address:
ZSigned :7,',7 Dole: A
Authorized Representative
Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer
LOCATION OF WELL (Please complete either la, Ib or Ic.)
l9 Borough Subdivision Lot BIoCk Ib. 1/4 qt rs.
�of_of_of—
Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
+ Street Address and Area of Well Location
2. WELL LOG
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological & Geophysical Surveys
Drilling Permit No.
A.D.L. No.
Section No. Township N❑ Range E❑ Meridian
S W�
3. OWNER OF WELL -1-_'-,,-
Address:
Feet Below
Surface
Bottom
4.
WELL DEPTH: (final)
5. DATE OF COMPLETION_.
I
6,
-,;;Q Cable tool Rotary ❑ Driven
E] Dug
❑ Auger E) Jetted [] Bored
[] Other:
7.
USE: E] Domestic E] Public Supply
❑ Industry
Irrigation 0 Recharge
0 Commerical
Test Well [] Other:
8.
CASING: 0 Threaded Q Welded
diam.
in. to c-: Eft. Depth Weight i < lbs./ft.
diam.
in. to ft. Depth Stickup ft.
9.
FINISH OF WELL:
Type: Diameter:
Slot/Mesh Size: Length:
Set between ft. and
ft.
Backfilling Gravel pack
10.
STATIC WATER LEVEL: (" ft.
t. "'�`'•'
EJ Above or O Below land surface
Date
Equipment used: ---- ---- -
I I . PUMPING LEVEL below land surface and YIELD
•- ft. after `' hrs. pumping '' g.p.m.
ft. after hrs. pumping 9 -p.m.
12.GROUTING Well _Grouted: Q Yes 0 No
Material: ❑ Neat Cement E3Other:
13. PUMP: (if available) HP
Length of Drop Pipe ft. capacity g.p.m.
❑ Subm. ❑ Jet Centrifical E] Other
14. REMARKS
16. WATER WELL CONTRACTORS CERTIFICATION:
15. Wafer Temperature _0
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief;
Registered Business Name Contract. License Number
Signed:.(� T,. ) !. _I r' - r' (_ Date:
X _
r Authorized Representative' �
Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -Customer
C] F El C
M
unlclpallty 01 Anchorage
Development Services Department
Building Safety Division
On -SRO Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.enchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. �4S'.�"1'� HAA# CA OW5
.Yi
1. GENERAL INFORMATION Expiration Date:
3/n os
Complete legal description GREAT DANE PARK SUBDMSION: LOT 3.
Location (site address or directions) 11031 GREAT DANE CIRCLE ■ ANCHORAGE. AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BART do
KAKI
GARBER
Day phone 344-0844
Individual Water Storage
❑
Individual Holding tank
11031
GREAT
DANE CIRCLE *
ANCHORAGE. AK 99516 '
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Day phone
Day phone 1.
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the onsite water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
Information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
onsite water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time of installation.
Name of Finn GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
More are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
—/ Approved for __q__ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing
Phone 337-6179
Date It It
WAiER�=�R
W pj 013
Attachments:
HAA Checklist _ Man' nance Agreeifi4 i r .
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: —t0.6. Original Certificate Date:
(Rao. 12o+)
Iw. ..
Municipality of Anchorage f
' Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
P 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us 9
(907)343-7904
e
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: GREAT DANE PARK SUBDIVISION; LOT 3 Parcel ID: 015-273-48
k A. WELL DATA *WELL DEEPENED ON 7/16/1986 I
Well type .PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed *10/13/198 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES I
i Total depth *212 ft. Cased to *212 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test *7/16/1986 11/8/2004
Y Static water level 163 ft, 147 ft
Well production 5g.p:m. 3.0+ 9-p- m. `
t
WATER SAMPLE RESULTS:
Coliform –.AK— colonies/100 ml. Nitrate4. le mg./L. Other bacteria colonies/100 m1.
Arsenic: N/A mg./L. Date of sample: 11 /8/2004 Collected by: GEG, LtD. q
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material __ S.T.E.P./STEEL Date Installed 8/26-27/1994
Tank size ' 1600 gal. Number of Compartments 2 Cleanouts (YIN) YES
k
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) YES i
q Date of pumping 9/14/2004 Pumper NORTHLAND PUMPING hr
C. ABSORPTION FIELD DATA PBELOW EXISTING cRA
jA Date installed 8/26-27/1994 Soil rating .p.d./ r ft=/bdrm) 1_2 System type TRENCH
# Length 32 ft. Width 2 ft. Gravel below pipe 8 ft.
Total depth *128 ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 11 /8/2004 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test . 80 In. Water added 757 gal. New depth 90 in.
Elapsed Time: 909 min. Final fluid depth 81
p in. Absorption rate >_ 600+ g;p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date –
1
j
Date installed 8/26-27/94 Size in
"Pump on" level at 43 in.
"Pump off' level at
41 in.
High water alarm level at 45 in.
Datum BOTTOM OF TANK
Cycles tested
3
Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots -100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through Held inspections and Iff n�•�i , •..Y*
review of Municipal records that the above systems are in i
conformance with MOA HAA guidelines in effect on this date. • , , .. • ...........
Q .J f e n
Engineer's Printed Name JEFFREY A. GAANESS QO"s� 7953
�4 rem •'••....... ••'.��pC+p�
Datef2� t— L. oProfe9slorlo
HAA Fee $ N0 • tao
Date of Payment f -7 loq
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
12/14/04 TUE 11:99 FAX, 5625485 PRUDENTIAL VISTA R.E. Q002
0
0
0
V
V
b
a
t•3
:Ll
n
r
rn
�04�.aA'•....... h9 C27
4p0000 not 4°°
oaoESED er:
C> O N N A O R R
t7fCI.)SION NOTE& it in the oWnen' respons@DI t0 detj—
the eldetense of my eaaemOnte, aovenante, or r =Io/ma
L
EGEND: SET FND
w/CAP® D/ar Rb O
with JACK WHITE COMPANY
Under Which no drewnamn on the recorded subdivision plat Ny
any data hareal bs acedUb
AL,NDH. Q} MONUMENTaenetruetlon
a for eatabllehlnohould
Property ones.
r TAac ffjJ9
CER71FICA71ON: LANTECH hot aandarHANG-'s`
M—
a_see=tRVEY
LM
Dhtsltal sully of oft Drowty m Phoan OOD
and that the lm rovwnente eltuatadNOzETE—
an Within the properly laces and no aneSPHALT-
DECKS- I�draWlnD
Lon
ments mist Other than noted
AKL-
LAND kCONSTRUCTION SUR1 EYORS-PIANNERs-ENGINEERS T oF: LEDAL OESCR1nc
sTANowPEs-
A WELL.
WEST BENSON Lw 103
ANCHORAGE,99503
WORK
(�07� 6�2 85291 LOT 30
ORDER NUM13�ALASKA440
DECFAWN. 03, � 1
2004 -50'
IV. -- NamliFt
GREAT DANE
PARK]
NRBftTdiE=
MW2535
REF o,l�D
" MUNICIPALITY OF ANCHORAGE
s DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650 ENVIRONMENTAL SERVICES DIVISION
343-4744
CERTIFICATE OF HEALTH AUTHORITY FEB 17 Nil
APPROVAL FOR A SINGLE FAMILY DWELLING R E C! V E Q
Parcel I.D. # 15 a�3 — 4a HAA # M 954
1. GENERAL INFORMATION
Complete legal description_ Low �,��� C4^j6 SID.
Location (site address or directions)
Property owner M/1� gF�� Day phone CQ
Mailing address C'0 'n-'�
Lending agency Day phone
Mailing address
Agent Jfr(c. Day phone -762—
Address 32a i sr Sc 1 / Zdo 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
P
3. TYPE OF WATER SUPPLY:
Individual well _2 �IG�_v�•
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOAx21
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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 furtherverify 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 ��--�-- ■�* -- �-
Address 7320 East Ches r
Engineer's signature
s d Rte, 0
�NvUlCr1
t
SUg&
22���—,—� J gi ice+
6. DHH/S� SIGNATURE
__v Approved for U7-- bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
Phone
33-2 --6, 1 "7`3
Date z // (�/9's
bedrooms, with the following stipulations:
Date E. Z3 191K
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 DHHS 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.
72-M (Rev. 1/91) BaCk MOA N21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: t-0-1- QParcel D.: 15 13- 4e)
A. WELL DAT
Well type (ZI Ufi ZiL If A, B, or C, attach ADEC letter. ADEC. water system number N A
Log present (Y/N) Date completed -7z6 L8L
Total depth 212 Cased to Z( Z
Sanitary seal .('/N) 1ZF-S
FROM WELL LOG
Date of test 7//6! g
Static water level
Well production
163
M
Casing height (above ground)
!2 f ��
Wires properly protected ")
AT INSPECTION
N7'
g.p.m. SM g.p.m. /
/l/1/y�c�r7�H 0aa-woawr✓ 7-0 /S8
WATER SAMPLE RESULTS:
Coliform Nitrate 1 r` " s \ Other bacteria
VolDate of sample: l (� Collected by:y •1 '�
I o•
B. SEPTIC/HOLDING TANK DATA s7 -F -P y�v�
f l
Date installed S Tank size /5Od Number of Compartments 2 Cleanouts")_,2—"'-
Foundation cleanout (Y/N) \li:S Depression (Y(� � High water alar�N)
/3 f"
Date of Pumping 2 9B Pumper l'7�" "� S6"cf`
C. ABSORPTION FIELD DATA
Date installed '8/ft4- Soil rating (g.p.d./W or ft2/bdrm) /' Z System type
Length 32 Width Z Gravel thickness below pipe 8 Total depth I Z
Effective absorption area 500 Monitoring Tube present (Y/N)-/— Depression over
field (Y/O
Date of adequacy test I )' 98 Results (Pass/Fail) ��sf For 6Ar bedrooms
Fluid depth in absorption field before test (in.); N/ Immediately after801 gal. water added (in.):
Fluid depth (ins) Minutes later: jayK Absorption rate = Awj - g.p.d.
Peroxide treatment (past 12 months) (Y/1I Noy LLQ If yes, give date /`J/^-
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed G/94-
Manhole/Access (Y/N) r S
High water alarm level at* 4-S-I/2�
Cycles tested 5-+-
E. SEPARATION DISTANCES
Size in gallons / S-0(]
a <,
"Pump on" level at* 4+Vq_ ± 'Pump off' level at* +/'s
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
EC17-!o'-7 off'7YlJlL
Septic/holding tank on lot I I `fit "� G/b On adjacent lots
Absorption field on lot 2S On adjacent lots /d0 /-1-
Public sewer manhole/cleanout
Lift station //+ / TV G�b
Public sewer main _ Pi
Sewer /septic service line /UO /+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
�
Foundation ZZ / ± Property line 45 / '- Absorption field 4-0 Pe2- (g `'14- 9,9-4
Water main/service line /0 /+ Surface water/drainage /00 r' Wells on adjacent lots /00 �f'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / Building foundation /D
Surface water
sf 0&
Curtain drain /")0.^J Lo we✓
Water main/service line
Driveway, parking/vehicle storage area _
_ Wells on adjacent lots /00 y
F. ENGINEER'S CERTIFICATION
I certify that I hav eter d th d i spections and review of Municipal records that the above sterns are
in conformance ith O AA ul line in effect on this date.
Signature
Engineers Name
Date
dv
HAA Fee $
Date of Payment r�
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICE$ R}�
Division of Environmental Services -
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # b ix-13 -48 -, HAA # AQcQ 10 C)1(,'A
1. GENERAL INFORMATION
Complete legal description
6�� 1
Location (site address or directions) 11031
Property owner to L Day phone 344 - O $5
Mailing address SSE Agoy�
Lending agency ^I �� Day phone "J.1A
Mailing address
Agent bo N N PC- oeja Day phone _762 - 3/ Z I 1
Address jw9m \A< -Y- W}-1 i'd-s- )-t1v _-74ci3
Unless otherwise requested, HAA will be held for pickup.
ti
2. NUMBER OF BEDROOMS: PLr_-g�-
3. TYPE OF WATER SUPPLY:
.! �p(y P1GIL—UPJ biZ.
Individual well
Community well��
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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aalem ails-uo all 'uolloadsul pue u011e6118anul Aw iuoaj pue sap; 96eaogouy;o Al!IedlolunIN all
woa; paulelgo uollewiqul all uo paseq legj Ajpanaaglan; l ,ulaaaq paleolpul ainlonals;o adAl pue
swooapaq;o aagwnu aql ao; alenbape pue leuolloun; 'a;es sl welsAs lesodslp aalemalsem ao/pue
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d33NION3 AS N01103dSNl d0 LN3W31VJLS 'S
Municipality of AnchorageRECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
Y 0 1996
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4
Municipality of Anchorage
Dept. Health & Human Services
Health Authority Approval Checklist
Legal Description: (rVr � ,P— Parcel I.D.: 01 S- -73
A. WELL DATA
Well type PV-wA� If A, B, or C, attach ADEC letter. ADEC Ovateer system number /J,4-
Log present (Y/N) �N F --C> Date completed _714&
Total depth 2 1 Cased to Z 1 -2- Casing height (above ground) Z 1 ¢
Sanitary seal (Y/N) \(*�-- S Wires properly protected (YfN) �I�S
FROM WELL LOG AT INSPECTION
Date of test -7 f i 4 A % S-z,C—A�
Static water level A/ 3 14-(o
Well production g.p. in
3.56 g.p.m.
N14XlH✓M D(l�^✓.00u/N "f 77 /60r I
WATER SAMPLE RESULTS: 3.56 6P/1 fv12- / & 21"gT'64 ' 15 Hr,jwj-16$
rzj5kVV6RjW C4>^PCr1 L
Coliform Nitrate m 1 o�/Q Other bacteria 4�
Date of sample: r-/ itP94 Collected by: G�iTi� S S
B. SEPTIC/HOLDING TANK DATA
Date installed f3cl4- Tank size /!;-00 Number of Compartments Z Cleanouts (Y/N)
Foundation cleanout (Y/N) Y6,& Depression (Y/N) /00 High water alarm (YN �L6S
Date of Pumping 5111-116 Pumper oxn NI COa.�a r�5.
s
C. ABSORPTION FIELD DATA
Date installed 9 94- Soil rating (g.p.d./ft2 or ft2/bdrm) I System type
Length -3 Z Width 2 Gravel thickness below pipe $_ Total depth �Z• 5 z
Effective absorption area 57W Monitoring Tube present(Y/I)Y Depression over field (Y/N) d
M
Date of adequacy test /SAd Results (Pass/Fail) PA -S For 4- bedrooms
O�
Fluid depth in absorption field before test (in.); &+2-"1 Immediately after 650 gal. water added (in.): 540
1
Fluid depth 4 5i2 (ins.) Minutes later: Absorption rate -->1 600 g.p.d. -�
Peroxide treatment (past 12 months) (Y/N) AJ If yes, give date AJ64
D. LIFT STATION
Date installed e3/94 Size in gallons I E3-00
Manhole/Access (Y/N) `I F, s "Pump on" level at* 4434n * "Pump off' level at* 41.5 "-
Yrrf
High water alarm level at* *Datum 'BaT'T-vM oP L. S
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
r
Septic/holding tank on lot On adjacent lots
Absorption field on lot 1 / ; On adjacent lots
Public sewer mai N 1A Public sewer manhole/cleanout
jp o Sewer /septic service line 100 / Lift station % / +
1,9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
et4-
3 Building foundation 2 Z —" Property line 4 5 t Absorption field A-0 W-�u
LX14 Water main/service line > tO r Surface water/drainage N ( )A Wells on adjacent lots > (Oy 7
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 15 ± Water main/service line
Surface water N IPr
Driveway, parking/vehicle storage area
65 of+
r
-pc—:.p-pc—:.p19ci4
Curtain drain N I.A. —� Wells on adjacent lots > 1 r Property line 35 .Spn L,
NauE o85i�v��
F. ENGINEER'S CERTIFICATION
certify that I have deterrAI� ejj th
in conformance ce x�h M��11�/� 9/1
Signature AA�
Vq
Engineer's Nanic,41 H
Date s�/ 7 /9.6
HAA Fee $
Date of Payment d- %
Receipt Number C 61 �S
Rev. 8/95 OSS: haa.wk.doc
actions and revieiv of Municipal re
effect on this date.
i
Waiver Fee $
Date of Payment
Receipt Number
ASS- 8u� ua-
are
,_ < g 116 0�dl I I� - 2
ff A. C3arness
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X° E-7953 �@
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MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING (�
HAA # fl 'l tE" O tFa
Parcel I.D. # 0 15 Q ?> ti
1. GENERAL INFORMATION
Complete legal description Lo I 3 C-IZEX
Location (site address or directions) I I b 3 l C nrr IaAA-A-L' i
Property owner n-� Day phone
Mailing address
Lending agency ?_0 1-1 ara st' -4143 Day phone a1 q- So 6-0
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: Li
3. TYPE OF WATER SUPPLY:
Individual well ( /z
Community well
Public water
NOT community well'systerrt,—provide written confirmation from State ADEC attest-
, = ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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 furtherverify 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 off✓ _e4 I TL E Phone XZ7? -3 q i to
Address A0 3 r.✓ 15 !-r N ,2a 3
Engineer's signature
6. DHHS SIGNATURE
,,K— Approved for
Disapproved.
Conditional approval for
Z
Additional Comments
Date q
'17•." l
bedrooms.
bedrooms, with the following stipulations:
�3AHTir
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 DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employeesof 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.
72-025 (Rev.1191) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: —1-o-1 3 6 bD v%c Par l/. Parcel I.D. Q15 P-71 i L'�
A. Well Data
Well type
If A, B, or C, attach ADEC letter.�ADEC water system number
Log present (Y/N) �
Date completed -/'Wen, Driller a SS
Total depth
Cased to
A/.2 Casing height 3o
Sanitary seal (YIN) `
—T
Wires properly protected (Y/N)rm
FROM WELL LOG
AT INSPECTION
72
Date of test
�
l!� 3
s
1 Lis
fTl
D
Static water level
Well flow
J90
g.p.m. F?.. 75 g.p.m.
o
W
< o r
Pump levell
J
n ! ° `'�
1 �' 2` �
y a
®
< 3�
SEPARATION DISTANCES FROM WELL TO:
m
Septic/holding tank on lot
I 1 q
; On adjacent lots
z
Absorption field on lot
1 2-� _!5
; On adjacent lots / r�
Public sewer main
tY�
Public sewer manhole/cleanout
Sewer service line
> / 6�0
Petroleum tank N
WATER SAMPLE RESULTS:
Coliform Nitrate a % 1�2 Other bacteria
Date of sample: �1' A! y Collected by:S
B. SEPTIC/HOLDING TANK DATA
Date installed "( A7A � Tank size % -tEO-e--E) Compartments
Cleanouts (Y/N) ` Foundation cleanout (Y/N) Depression (Y/N)
High water alarm (Y/N) Alarm tested (Y/N) /
Date of pumping q11,4, Pumper /A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
On adjacent lots i / (9-0 Foundation
To property line Absorption field
q 0 Water main/service line > (7
Surface water/drainage N 0 N E -
CONTINUED ON BACK PAGE
72-026 (3/93)` Front
C. LIFT STATION
Date installed R/ �_ Z /,?
Size in gallons
/C'Y�
Manufacturer 04lUC Go f�
Manhole/Access (Y/N)
Vent (Y/N) "Pump on""/ level at V3� "Pump off" Level at
`7�
High water alarm level • Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot y On adjacent lots U
D. ABSORPTION FIELD DATA
Date installed g/9-62 /�I
Length 3 2--• Width
I/
Surface water N\ G 4 -e
Soil rating (GPD/Ft2) �. 2 System type �iC LUI
Gravel thickness Total depth l
Z.
Total absorption area
r%�
Cleanout present (Y/N)
D
Depression over field (Y/N) �1 u
Date of adequacy test
1-/ lle�
Results (pass/fail)
7�
(
for t_/ Bedrooms
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
After test
yes, give date
Well on lot / oP-S On adjacent lots ,�) / 0-e_�) Property line _
To building foundation Is To existing or abandoned system on lot
On adjacent lots > Cutbank No /`l if- Water main/service line
Surface water 1\4 v Driveway, parking/vehicle storage area } 3,—Q
Curtain drain l��o
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect bn the date of this inspection.
Signature
Engineer's Namev ✓
Date I/ Vi `F
i
HAA Fee $ ���q` Waiver Fee $
Date of Payment / y` l Date of Payment
Receipt Number 7Z ��� ��� / Receipt Number
vn nnc in ine. o....,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL J I�'1 _ D� q,
I
OF ON-SITE SEWER AND WATER FACILITY T I / I
264-4744
Application Date y -7'
1_ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
3 '3 (f / Die Su4 Sz/
Localtar� (aYlressrlfi�2'ons)
Da12e
(b) Prop'trrtt , Ownersi
Mailinga AddressL AN
KXBi�lra s<nA+te�a�lsA
h
(c) endigg �t-p$-�`;
s
Mailing Address�
(d) Real Estate Coinp'any and Agent
Address
Telephone
(e) Mail the HAA to the following address: or: Check here c1, if hold for pick up.
List contact pexso nd ay one num a below.
Telephone: Home
T_T
Telephone
2. TYPE OF RESIDENCE
Single-Family.f
Number of Bedrooms _
a
Business
L-
3. WATER SUPPLY
Individual Well g 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 o 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 n -ole (Rev 8/88) Front
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elep az (!eue ao suo!loadsut lonpuoo lou op SHHO to saa (o!dw3 'sluewaainbai alels pue !eaapal weliao (s!les of aapao
u! suo!lnl!lsui 6uipualpia41 pue sawo4lo siasegoind of (selanoo e se s!4lsaop SHHCl agl'uIse!V to a1e1S a41 u, paaals!6aa
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lenojddV lluo4lnV 411eaH sanss! (SHHO) saa!AaaS uewnH pue 4l!eaH to luawlaeda4 a6eaogouV to Al!!ed!ownlry a41
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panoiddesi4 panoaddV
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ao/pue Alddns aelem al!s-uo o41 'uo!loadsui pue uope6!lsanu! Aw woal pus sa!!l a6eao4ouV to Al!!ed!o!unlN a4l woal
pauielgo uoilewaolu1 a41 uo paseq 1e41 (l!aaA jaglanl ! 'u!aaa4 poleo!pui eAnlonals to od (1 pue swooipaq 10 jagwnu a41 iol
alenbope pue !euo!launl'ales s! wags (s !esodsip aalemalsem jo/pue AldcInsialem alis-uo a411s41 smogs Jenoaddy Al!aoglny
4lleaH s!4110 uoile6!lsanui Aw 1e41 Al!aaA ! 'Mo!aq UM04S alep uoilep!!eA a41 10 Se pue olaaa4 pax!lle leas Aw Aq polpliao sy
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P�\�I OF�RNGEsv�J` MUNICIPALITY OF ANCHORAGE (MOF.t
HEALTH AUTHORITY APPROVAL (HAA)
�\Rp�ME �C?d�� CHECKLIST - FEBRUARY 1984
tiN fp 264-4720
Leal Description:
/ 7-1 AA/ �✓
A. WELL DATA
Well Classification PR 1 ylyrc If A, B, C, D.E.C. Approved (Y/N) /,///k
Well Log Present &N)Date Completed 7/ 161042 Yield 0 ✓��t
Total Depth dd a' Cased to 9 f Depth of Grouting (CCN t, m2 I'VN
3`/ Pum
Static Water Level P Set At d � 7/
Casing Height Above Ground — f ,�
Electrical Wiring in Conduit (Y N)
Separation Distances from Well:
Sanitary Seal on Casing
Depression Around Wellhead (YV
To Septic/Holding Tank on Lot 00 /f ; On Adjoining Lots /00 /_f --
To Nearest Edge of Absorption Field on Lot 1001 ; On Adjoining Lots /00 /+
To Nearest Public Sewer Line -AA9Y_C To Nearest Public Sewer
Cleanout/Manhole No �4/`✓ To Nearest Sewer Service Line on Lot NDS/r'
Water Sample Collected by P, dF-tP ; Date
Water Sample Test Results S;A% (5rnc7c'ZS/
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed _ flf Size I o'� U9 No. of Compartments TWO
Standpipes &N) Air -tight Cap&/N) Foundation Cleanout dN)
Depression over Tank (Y/O Date Last Pumped 5� 5 �
Pumping/Maintenance Contract on File (Y/N) _ A ; for NIA
Holding Tank High -Water Alarm (Y/N) (yld Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well l M ( -11 - To Building Foundation l
Td Property. Line. W4 To Disposal Field /
;o Water"Main/Simfte Line ��0€1 C' /'veev To Stream, Pond, Lake, or Major Drainage
bourse �t�? P /r✓N��F
^" Comments
OF 9
"Page,.rof 2°
C. ABSORPTION FIELD DATA
Soils Rating in Absorption SC/1
rtrra a I Fj Q b Type of System Design i—RIC&(
Date Installed C� Jsi �f Length of Field �7 5 i
Width of Field r? Depth of Field
Gravel Bed Thickness �r -
Square Feet of Absorptionrea 11�1 Standpipes Present (ON)
Depression over Field (Y/P) Date of Last Adequacy Test -7
Results of Last Adequacy Test �/ i5 EAC (ogy-
Separation Distance from Absorption Field:
To Water -Supply Well 1 D() / To Property Line
To Building Foundation 30/4—
Lot
FAIJ
On Adjoining Lots
To Existing or Abandoned System on
To Water Main/Service Line N04 F lvNov To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course /low r9 /I /��✓
To Driveway, Parking Area, or Vehicle Storage Area4'- ()/
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) _
Comments
Dimensions
nhole/Access (Y/N)
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request **
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I h v c e ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
i
Signed `�T Date l� WIMAVA
y
Company MOA No. .damG ®F At "%% �� e•
Receipt No. Off; a•
// � �r : 'T9T •�* w
Date of Payment (� see.... . ...• a•e.Z• •g
o A �
Amount: $ /ti 0 0 P '.e••., ;s g ...
�$
tER C, REID, It.
°. CE -251
-°.�.
Page 2 of 2
72-026 (11/84)