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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 " L" Street, Anchorage, Alaska 99502, Telephone 264-472.0
ON-SITES SEWAGE DISPOSAL, SYSTEM AND/OR WEELL. INSPECTION REPORT
Name �p
A—' �k' r' L
DISTANCES
�s TO
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
-'�
Planets) Permit No. ffo of Bedrooms
'7t5 I
WELL
LOT LINE
1
e LEGAL DESCRIPTION
Lo:Block Subdlvismn
�—� I
FOUNDATION
1 �f
—^--�
Township, Range. SCOOn
4—
I� � _
TANKS
ASDIADIAGRAMtShov: location of well.ll,
dnvew ew y.. y. water bodies, etc.)
4
-
septic system, property lines. loundabon.
—
SEPTIC ❑ HOLDING
Maaa�t un�acc_.tu'�reer (
CIS[/
Capacity in gallons
— V
—
_
Material
No of Compartments
--� TYPE OF SYSTEM
❑ TRENCH BED _7_�_
Depen to pipe bottom ham
original grade
RII adtletl ahovc original grade FT
Gravel len------
gth
FT
total absorption are
SQ FT
Number i tin's Soil rating
SQ FT
Installer
W. DRAIN ❑ OTHER
total depth from onjinal rade
FT
duel d1i th pipe
�_ _ FT
.647
-
——_
t
—
C ravel wWth
FT
Distance between lines
FT
Pipe nreterial
Dale Installed
--
—
G.v
>_
--
WELLS
o
I
)
I
1
f
�RIVATE El OTHER (Identifv)
ClasshcabonfA.B. GI -
Installei `
total Depth Cased to
- FT FT
Dte aInstalled-
t'
— I
!
..
U
REMARKS:
l—LCz: jz—!! .
Scale: ( ,4rO
Inspections; eiformed by.
ENGINEER'S SEAL
�. .H••
n
i✓ ��� • •••��. >..•„� � ,
t .� A tyAaFme � aF
�. I A.157ai i t`ry i
pp q t/
Pill(( -'`"s�
Date. q _ _
1
c u s NGINEERINC certify tha his
77�ag 4 F_ac�1 River Loop Road No. 204
Municipalaylet��veil;It�ls�l�9ale: f
``
✓
Health Department Approval: __!_ 4 _
inspe lion was perionnetl accardiRh to all
���
—
_ Date.
r|�N1L1PAL11 Y UF HNCHORAG[
UepartmenL o� Health & Human Services
825 L StreeL, Anchoraqe, Alaska 99501 313
OE SEPlIC TANK PERMIT
Pcr:�, !\,': '`'er: 880181 Up�rade
Da(e 11:sued: 09/O8/88
Own^`�u:"AK, HDUSING F1NANCE Day Phone:
AVE 276~5599
ANCHORAGE, AK 9951O
Parrel Id: 051-07 75
Lnt Le�al: Subdivision: SARAHDOG Lot: 1 8lockN ~
Section: 4 [ownship: 15N Ranqe: 1W
LotS�ze 48000 (sq^|t, or acres)
s�x Gedrooms: lhis Permit: 3 loLal Capacit;: 3
|ANK: Minimum in septic tank capacity: 1,000 (lax 11army. Each septic
!^|mvst have at least 2 comparLments" Depth Lo Lop o{ septic tank (es) < 4.0
'�eL 'equirones insuI'M iun over tank(s).
1 CEHliFY THA/:
�. l am ;ami1iar wi�h Lhe requirements {or on~site sewers and wells as set
(mth by Lhe Municipall. ity o[ Anchorage (1100)) and the State of A1aska,
2, | w : 1i �/istall the system in accordance with all MOA codes and regulations'
��/d in compliance w1th the design criteria of this permit.
J, � will adhere Lo a1l MOA and State o[ Alaska requirements for the set back
distances from any existing we11, wastewater disposai system or 10u1)1ic
sewerage system on this or any adjacent or nearby lot"
4 ' /,derstan s permit is valid [or a maximum o� 3 bedrooms, I
a1sounders ha the capacity of the total system is 3 bedrooms and
,nlarqeme0t wil/ require an addiLional permit"
(Owner)
l�//ued 8y:
DATE:
/
DATE:
6 GC -
SCALE
i
a \c t !
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AiJCr!ORP.GF. PL:,{<,a ; 9f02-1:
i
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850430
Lot 2 Sarandog Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On --site Services
SEO/ 1j w
enc: Copy of Permit
X CS: 1: F:` C:::::: [I - - 11�������
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, Al-::: 99501
264 20
U1 �%, 11 ...... ���� ��������� �� ����~� ���It-11 I T-
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT F'HONE:
850430
07/19/85
DALE AND CAROL DEFREEG
SR2 BOX 4801
CHU(3IAAK 99567
694~9571
LEGAL DESCRIP: SUBBIVISION:
SARAHDOO
LOT: 2 BLOCK: NA
SECTIO�: 4
TOWNSHIP:
15N RANGE: 1W
LOT SIZE: 40000 (SQ.FT"
OR ACRPS)
LOT iOCATION: YARNOT ROAD
MAX BEDROOMS: 3
Listed below are the options
available to
you in designing your septic
system" Choose the opticn that best fits
your site"
117 11,11
DEPTH TO PIPE BOTTOM (FT
3"5
3.0 **
GRAVEL DEPTH (FT,)
0,5
1"0
TOTAL I)EPTH (FT.)
4.0
4.0
GRAVEL WIDTH (FT. >
17"0
5"0
GRAVEL LENGTH (FT")
34^0
66"0
GRAVEL VOLUME (CU"YDS")
21"5
18~4
TANK SIZE ((.3ALS)
1,0O0^0 **
19000"0 **
SOIL RATING (SQ"FF. /BR)
125
125
** DEPTH TO PIPE 8OTTOM <
3"5 FT. REQUIRES INSULATION
*X. DEPTH TO PIPE BOTTCAM < 4.0 FT" MAY REQUIRE
A LIFT STATION
** TANK MUST HAVE" AT LEAST
TWO COMPARTMENTS
..... ..... ... ��������������
l certify that:
1, I am f,afit iliar with the requirements for on~site sewer5 and wells as set
Forth by the Municipality of Anchorage (M(3A) and the State nf' Alaska"
2" I will install the system in accordance with all MOA codes aDd regulations,
and in compliance with the design criteria of this pePmit"
3" I will adhere to all MUA and State of Alaska fc)r the set back
distances from any exif�'iting well, wastewatep disposal system or public
sewerage syotem on this or any adjacent or nearby lot"
4. I understand that this permit is Ya -1 -id for a 0aximum at' 3 bedrooms and
any enlargeme1"It will uiPe an additional perqoit"
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 (Z) THE
ELECTRICAL W I�E�SED ELECTRICIAN"
'
SIGNED aeq_n,-
DATE: ��I��-
�����_~~��
_�~~_�~'� �.��l�..~~~�
APPLICANT: DALE AND CAROL, DEFREES
ISSUED BY J /D DATE
'�., SvOILS 1.OG
MUNIC11'AI_ITY OF ANCHORAGL.
y® �f DEPARTMENT OF HEALTHAIT--- ENVIRONMENTAL. PROTECTION ' P6_RCOLATION
Street Anch.nr;,,,,. +s!m ogrgt Wil 4720 'fESI
F)Q!K,S LOG -- PEiiC:OLATION TEST
PERFORMED FCR: DATE
LEGAL DEscRll noN: __ cl _
SLOPE Sfl-I PLAN
(. (I,
2 �� Ij
(G -W)- 9
3 6 C J
" ! S0. •, aE q Q r4 VC -
6
12
• O1,— e1,✓%'C�
rI
18 )o. 2225-b., ^P '
20 -
PERCOLATION RA ri
TEST RUN BETWEEN
COMMENTS
SVA^ GROUND VVA I R
CN000N rEREW _ tvy) (>,t.e.P`J (...-_
if- YES, AT WFI,,T E .I. -
DEPTIii
Roarling
Dane --Gross..__^
Time
—
i
- ----
I
Net
Time
III--- —
__. Wate'D'op`
Depth to
W1
—j
--
I
----
— --- —
PERFORMED
72008 (61,79)
F'r AND - F i-
�+ %
CER nr-Ir:D t3v:.l...r`.�..—._— _-_----_ DnrE:iY�.1'� �_._...
MUNICIPALITY OF ANCHORAGE
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTL,;TION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
❑ NEW
//�'.J �7 I "/
•_
UPGRADE
MAILIfQGADDRESS ✓.�t�x 51,36 O Calc-
LEGAL DESCRIPTION
Z- 3.5 S
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
v
_Y
a z
Manufacturer ��. 0� �-,
—
Material
No. of compartments
wF
tn
Liq, capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
O Y
z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
2 � h
Manufacturer V
Material
Liquid capacity in gallons
0
DISTANCE TO:
Well/� ,�
Font .,.�L
`
Nearest I t,.jine
�}
PER MIt
-- -
w u.
No. of lines
Len th f ch liner a
Total I a. h of liryes-7L
v —
Trench idtl
5 inches
Distance be line'
Top of rile ty2finjsh grade
f^
ter�al�erleLtrr t j/
Total eff rive a orp; area
>�
inches
w
Length
Width
Depth
PERMIT NO.
(7
ct k-
Wa
W
Type of crib
Crib da r
Crib depth
Total effective absorption area
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
De th /
Driller
Distance to lot line
PERMIT NO.
J
w
DIST NCE T
o il/dingttfoundatioV
Sewer line
Septic tank
Absorption area(s)
OTHER
-
-
PIPE MATERIALS
/,(l
SOIL TEST RATIrGJ70.//�9 2
INST LL
RE RKS
-lwd ��� ��
Flu«
INN
-
"I
no
�(
I�—
;F
i\u b:i'i A.
rya a>
LEGAL
r�
z�tlJ
'
�j�J
r
q
1 rl
L/U 1'y 1Nev. 3//25) 1 /
TYPE Of.: ABSORPTION : _,vsTEH " : 1•1E:FI I kIF I E LD
t'IFI<;Tt'II_Ih1 I'dUl'IE.EF: OF C;EC:F:uCrt9_ 3 : CiIL RATING f:::.0 FT, -,'BR.' -,l= :0C
THE RECKI: RED SIZE OF THE :=;OIL ABSORPTION 'm.'rSTEll IS
R - II R ..R -._ R__•. � F -J (:� '•Y` F -Y - ::. �q ; ". u =' u_.I °^„°° R :: R_._ R:.;:° Imo- F--' .'li _ R --II = = q
q •_ RZ F^ D: �q
THE LENGTH C:, I r'IEI'•a I ONd IS THE LEND"rH 1. Nd FEET) OF THE TF:Et•-IC:H OF:
THE DEPTH OF H TRENCH OR PIT IS THE DISJAt•CE BETWEEN THE SURFFIC:E OF THE
iaF••:i UI, -JD AND THE BOTTOM OF THE E:;GAVATICIN"IN FEET,).
1-11--R VE _E 04. F' R^ -°R C. II --A U4 I R.T.° -y- R --Y A': 15 _ 1211 CEO n --En F:- E^ F -.-.-'T"
THE GRAVEL DEPTH I: THE 11INdINLII'l DEPTH OF Cl,RA'v'EL BETWEEN THE OLITFAL.L_ F,IPE
AP -Jr.:) THE E,OTTON OF THE E::C:H'-r'HT I i_it•,I c: I Nd FEET:,.
1= R R E=q °M° R= R= ^ _R._ ]C C.: -F n PA R = a 1 `E :11_ C --n C -112b a -i F:11 R_.. IC:K R° 9
PERr'I I T APPLICANT HAS THE F:E=;F'ONd I. B I L I T'r' TCi I NdFORI,-I TH I 1'.: EPFiRThlEt•,IT DIJR I I'-4Ci THE
IhISTALLATIOhl II'•dSPEGTIONdS OF ANY WELLS FIDJFiCENdT 'TO Tt-IIS, F'F!CJPER.T',' AND THE
I'-4IJr'IBER OF RESIDENC:ES THAT THE WELL bd l l_L. 'SER% E.
- --
1-W c ll " Q =.q I R^-4 S-.-. V-` R= U," -'T- .R: IC -'D R^ -°R F O F:” IES F.- IEE G! 6_, w :A FR"' R��; Y _. __.. _.._.
E,AC:K:FII_LIhIG ("IF' ANY S'TSTEl"I WITHOI_IT FINAL INSPEC:TIOI%l E•IhID FIPPF:OVAL BY THIS
i_lE:PAF:TI''IEY•-IT I••dILL. BE E,I_BJEC:"r TO PROSECUTION.
I'III'•411''1Jr'I DISTAI'•dC:E BETWEENd A IdEI_I_ AND AI,Tr' ON --SITE SEI AGE C:-:['Sf-,Ci:-::;AL `'•r'-T'Ehl I_+
100 FEET' FT -IR A PF:I'v'ATE L.IELI._ OF, J_50 TO 200 FEET FFCIM F -I PUBLIC: WELL DEPENdCJIP%IG
LIPCINd THE TYPE OF PI -IL -:LIC: WEL.L.
r'I l ll l l,lUt'I D I STAN C:E FROM A PRI % ATE WELL TO FI PR I'y'ATE : EL.II: f:: L. I t -IE IS 25 FEE"[' F II'dC:
TO A COVII'll_INd I T''r' SEWER LINE IS "lr-; FEET.
OTHER F:EQI_IIREPIENdTS I"'IFI'r' APPLY. SPEC: IFICATiori ; AND ARE
FP,'A I LABLE. TO INSURE PRCjPER I Nd_;TALL.AT I OI, -4.
^T:E EEC` R="I---RR R_:
I GEF7.TIFY THAT
1: 1 All FAMILIAR I.d 1 TH TFIE REQUIREMENTS FOR, ON --SITE TE : ,EIxIEET:_, Fir -41:1 AS : E: T
FSU?TFI BY T'HE I'il,.ihd:EC:T:F'AL_1T',' CiF ANCHORAGE.
2: I WILL I N STAL. L THE SYSITE::t'I IN AC:C:ORDANC:E WITH 'THE GC1r.*,F- ,.
1 I_il'Il'E:f=:;TFltd[; THAT THE OhI-.:;ITE SEWER S'r'E-1-Et'I 1, -,-1 r-IEQLIIF�;E Et,IL.AR Er'IEI'•dT IF THE'
RES IDEI'•dC:E. IS; F:EPIi-IDELED TO II'•dGL.I_IDE MORE THAN E:EDF:Ci011,
FiFfi-
C:I=IYdI'M:1 C:HHF�:C; F- F:Cn�:H I I'•d
c- -
ISSUED B',...___._ �C_�_��� C: FITE'_...���
w r1l S' /J-r\/y, _ 5
-T/Cy"f1;3I�c'T LOLL
G -r i�S�✓'>ri
DEPAF:Tt9ENdT OF HEALTH
ANC, EYd'r' I E:CaI',If'IF_tdl"I=1L r'`"', rEl; r.r. i_il'd
m :'= ''L.LF':EET,
FINdC:HOFAGiE,
AK '=9
co
It' -4 F.
Ems: R.^ -Y Imo'::
IFina
R'° R :IC •1`
C
APPL.I GANdT
R I I ->IAF D 1-1
f�;or:l-I I Nd
=R2 BCI:,.*,' :L-2:171
1--Q.-.,ERC-3i
F-1? ':?95 r
G c'M-'=�2..-.,2
L,_„-:Fi-I- I ON
LEGAL.
L-37`5 S144 S 4
T.15N R11 -d
LUT
SIZE "99'999
SIDUARE, F :ET
TYPE Of.: ABSORPTION : _,vsTEH " : 1•1E:FI I kIF I E LD
t'IFI<;Tt'II_Ih1 I'dUl'IE.EF: OF C;EC:F:uCrt9_ 3 : CiIL RATING f:::.0 FT, -,'BR.' -,l= :0C
THE RECKI: RED SIZE OF THE :=;OIL ABSORPTION 'm.'rSTEll IS
R - II R ..R -._ R__•. � F -J (:� '•Y` F -Y - ::. �q ; ". u =' u_.I °^„°° R :: R_._ R:.;:° Imo- F--' .'li _ R --II = = q
q •_ RZ F^ D: �q
THE LENGTH C:, I r'IEI'•a I ONd IS THE LEND"rH 1. Nd FEET) OF THE TF:Et•-IC:H OF:
THE DEPTH OF H TRENCH OR PIT IS THE DISJAt•CE BETWEEN THE SURFFIC:E OF THE
iaF••:i UI, -JD AND THE BOTTOM OF THE E:;GAVATICIN"IN FEET,).
1-11--R VE _E 04. F' R^ -°R C. II --A U4 I R.T.° -y- R --Y A': 15 _ 1211 CEO n --En F:- E^ F -.-.-'T"
THE GRAVEL DEPTH I: THE 11INdINLII'l DEPTH OF Cl,RA'v'EL BETWEEN THE OLITFAL.L_ F,IPE
AP -Jr.:) THE E,OTTON OF THE E::C:H'-r'HT I i_it•,I c: I Nd FEET:,.
1= R R E=q °M° R= R= ^ _R._ ]C C.: -F n PA R = a 1 `E :11_ C --n C -112b a -i F:11 R_.. IC:K R° 9
PERr'I I T APPLICANT HAS THE F:E=;F'ONd I. B I L I T'r' TCi I NdFORI,-I TH I 1'.: EPFiRThlEt•,IT DIJR I I'-4Ci THE
IhISTALLATIOhl II'•dSPEGTIONdS OF ANY WELLS FIDJFiCENdT 'TO Tt-IIS, F'F!CJPER.T',' AND THE
I'-4IJr'IBER OF RESIDENC:ES THAT THE WELL bd l l_L. 'SER% E.
- --
1-W c ll " Q =.q I R^-4 S-.-. V-` R= U," -'T- .R: IC -'D R^ -°R F O F:” IES F.- IEE G! 6_, w :A FR"' R��; Y _. __.. _.._.
E,AC:K:FII_LIhIG ("IF' ANY S'TSTEl"I WITHOI_IT FINAL INSPEC:TIOI%l E•IhID FIPPF:OVAL BY THIS
i_lE:PAF:TI''IEY•-IT I••dILL. BE E,I_BJEC:"r TO PROSECUTION.
I'III'•411''1Jr'I DISTAI'•dC:E BETWEENd A IdEI_I_ AND AI,Tr' ON --SITE SEI AGE C:-:['Sf-,Ci:-::;AL `'•r'-T'Ehl I_+
100 FEET' FT -IR A PF:I'v'ATE L.IELI._ OF, J_50 TO 200 FEET FFCIM F -I PUBLIC: WELL DEPENdCJIP%IG
LIPCINd THE TYPE OF PI -IL -:LIC: WEL.L.
r'I l ll l l,lUt'I D I STAN C:E FROM A PRI % ATE WELL TO FI PR I'y'ATE : EL.II: f:: L. I t -IE IS 25 FEE"[' F II'dC:
TO A COVII'll_INd I T''r' SEWER LINE IS "lr-; FEET.
OTHER F:EQI_IIREPIENdTS I"'IFI'r' APPLY. SPEC: IFICATiori ; AND ARE
FP,'A I LABLE. TO INSURE PRCjPER I Nd_;TALL.AT I OI, -4.
^T:E EEC` R="I---RR R_:
I GEF7.TIFY THAT
1: 1 All FAMILIAR I.d 1 TH TFIE REQUIREMENTS FOR, ON --SITE TE : ,EIxIEET:_, Fir -41:1 AS : E: T
FSU?TFI BY T'HE I'il,.ihd:EC:T:F'AL_1T',' CiF ANCHORAGE.
2: I WILL I N STAL. L THE SYSITE::t'I IN AC:C:ORDANC:E WITH 'THE GC1r.*,F- ,.
1 I_il'Il'E:f=:;TFltd[; THAT THE OhI-.:;ITE SEWER S'r'E-1-Et'I 1, -,-1 r-IEQLIIF�;E Et,IL.AR Er'IEI'•dT IF THE'
RES IDEI'•dC:E. IS; F:EPIi-IDELED TO II'•dGL.I_IDE MORE THAN E:EDF:Ci011,
FiFfi-
C:I=IYdI'M:1 C:HHF�:C; F- F:Cn�:H I I'•d
c- -
ISSUED B',...___._ �C_�_��� C: FITE'_...���
w r1l S' /J-r\/y, _ 5
-T/Cy"f1;3I�c'T LOLL
G -r i�S�✓'>ri
® & E ENGAEERING & ®EVELOr AENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 686-2280
Performed for: Name: /� /�/�- D L / ��� �' �' �`/ / N Tel. No.
Mailing Address: Z11�r Z- /�o X `j / �G r /�-�� /21), ("Ucz'm
Legal Description: /5L /W 4 c) / =' 5 VV �4y S E (- P / W , Al.
Depth (feet)
0
Soil Characteristics
L_ C7
C t. J
2 -- �--
All t
3 —
4 _
5 /ate• /'` c: / ��s'T_
7
0
10 --
11
12
13
14
15
16
c) C) ^-`-T//9 '12 ,
PLOT PLAN
IV u jC:11La,
PTC. TEST
� —1c',C) ,
OF 'q4'W9
Co.esr
Ground
U(
Ground Water Encountered: Yes No If yes, what depth f �jerr
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: —
(r�®'6ae,/Q'COG /g COO O��A'deo. e�en.Crteo. r
60480,
®. m Earl P. Ellis 1 w.d
4 R0FE
�
Date: /
SEEPAGE
GRr-fkTER ANCHORAGE AREA
SOROUr7H 0"V-6
_, OFTLINESNGTH� ,
WATER
HEALTH DEPARTMENT
TRENCH WIDTH
DEPTHS
327 EAGLE ST. ANCHORAGE, ALASKA
99501 27y-2511
SAMPLE
INSPECTION REPORT ON-SITE SEWAGE
DISPOSAL SYSTEM
/4,'.7/, SEPTIC / ! SEEPAGE
u^' � ,TANK !oQ SYSTEM
`-7 C
/ WCG
, CESSPOOLS
OTHER
SOURCES_
NAME
MAILING
ADDRESS
l'0y��Z C�IICC
PHONE__
LOCATION -N- �� f�-� ��64i�
LEGAL DESCRIPTION
tai �f ,J
SEPTIC TANK:NUMBER
f M
l /
-L
OF
DISTANCE FROM WELL
MATERIAL l%
OMPARTMMENTS
LIQUID CAPACITY /aC9�
GALLONS. INSIDE LENGTH
INSIDE WIDTH -DEPTH
IDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT
NUMBER OF PITS
LINING MAT
NEAREST LOT LINE
TILE DRAIN FIELD:
OR WI
D FROM WELLp
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
I
BUILDING FOUNDATION ,
SQ. FT.
°O", , FOUNDATION ��0/
DISTANCE FROM WELL 1,2e",
NEAREST LOT LINE
DISTANCE FROM
_, OFTLINESNGTH� ,
WATER
NUMBER OF LINES DISTANCE BETWEEN LINES E U
TRENCH WIDTH
DEPTHS
IN. TOTAL EFFECTIVE
,rr
ABSORPTION AREA JaSQ. FT. LENGTH OF EACH LINE
SAMPLE
7'
NEAREST
LOT LINE "� SEWER LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:
��[ j/
7
DISTANCE FROM
/� /
60
WATER
TYPE rel
DEPTHS
BUILDING FOUNDATION,
SAMPLE
�NEAREST
NEAREST
LOT LINE "� SEWER LINE
/4,'.7/, SEPTIC / ! SEEPAGE
u^' � ,TANK !oQ SYSTEM
`-7 C
/ WCG
, CESSPOOLS
OTHER
SOURCES_
DISTANCES:
DIAGRAM OF SYSTEM
.-z GREATE. ANCHORAGE AREA )ROUGH Case No.�®
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279.2511 ij
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME 01= APPLICANT rV1W AW1 MAILING ADDRESS /64 12- PHONE NO,�_y ?W0
RESIDENCE ADDRESS LOCATION OF INSTALLATION ��//`t� 2
1 & CjQe�
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE
/P,IT , DRAIN FIELD_OTHER
TO SERVE THE FOLLOWING FACILITY '-;' 19el"wW
FINANCED THROUGH ��i TO BE INSTALLED BYL%`��
PERCOLATION TEST RESULTS
ANTICIPATED DATE OF COMPLETION— (�'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS o`�`�/�� ' PERMIT TO INSTALL A�1�l��1U
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
DISTANCES:
SEPTIC TANK SIZE
�/-e,(
X� � - v
kav '
It
6 46V1
(Or
61.V
Health Authority
TYPE—_ SEEPAGE AREA
DIAGRAM OF SYSTEM
TYPE
Vertify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No, 28-68 and that the
above described system is in accordance with said code.
,� %� �
0ATEj�U�""v`r _ APPLICANTS SIGNATURCI,- L- `
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Vertify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No, 28-68 and that the
above described system is in accordance with said code.
,� %� �
0ATEj�U�""v`r _ APPLICANTS SIGNATURCI,- L- `
MUNICIPALITY OF ANCHORAGE
• -r Department of Health & Human Services M 1
DIVISION OF ENVIRONMENTAL SERVICES M
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel 1. D.# C)A—='q Q HAA# 0 (--
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
LUT IA SARAHOOG SUBDIVISION
Location (address or directions)
(b) Property owner Akaeha Hou.6inq F.C. Telephone: (home) Business Sit -1900
0484,5
Mailing Address 520 East 34th Avenue Anehanage Ataska 99503
(c) Lending Ihstitution Tol"h^"P
Mailing Address"
(d) Real Estate Company and Agent JACK WHITE COMPANY ATTN • Ln
Address 10923 Eagle Riven. Road Eagte Riven, A Aka 99577
Telephone 6V4 -
(e) Mail the HAA to the following address: (or check hereg if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road No. 204
C--'e-ftiv
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms 3
3. WATER SUPPLY
Individual WeA� Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site XX 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.
72-025 (Rev. 7/88) Page 1 of 2
5. 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
S & S ENGINEERING
Address 1703,4Eagle River LocP Road No 204
Date Eagle River, Alaska 99577
/qf"r^� 4
r �
re. W49
6. DHHS APPROVAL �j
Approved for "_ bedrooms by --kZ,�tZDe--- �`�-6'5;e
Approved_—Disapproved Conditional
Terms of Conditional Approval
CAUTIONS
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. Employees of DHHS do notconduct 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. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984 QN,
343-4744
Legal Description:
��� _� �+ I >✓ l�ca�sj L)
A. WELL D'
Well Classification yJoJ/&L. If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y p Date Completed Yield Z 61 m 4
Total Depth J% Cased to �" -� Depth of Grouting '� ���
Static Water Level Pump Set At
_ r ,
Casing Height Above Ground j
Electrical Wiring in Conduito/N) Depression Around Wellhead (YIW J�
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot \ ; On Adjoining Lots t CU
To Nearest Edge of Absorption Field l o Lot 4> ��` ; On Adjoining Lots';
To Nearest Public Sewer Line Iv To Nearest Public Sewer Cleanout/Manhole N Q
r
To Nearest Sewer Service Line on Lot r
Water Sample Collected by ' 1 f'e/ r ; Date
Sanitary Seal on Casing Q91\1)
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed q X43 -06 Size % 000 No. of Compartments _
Standpipes(9/N) Air -tight Caps4V/N) Foundation CleanoutQYIN)
Depression over Tank (Yo /" D to Last Pumped (: _ Z'5 _ 8 M;V-1-1
Pumping/Maintenance Contact on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well l� 1 To Building Foundation
To Propefty Line
To Water Main/Service Line
To Stream, Pond, Lake or or Maj`o�rr Drrai
Comments 1'1Wf�' CYC
To Disposal Field
r,
Course J
72-026 (Rev. Masi Font Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata �� �i ^►A Type of System Design�—>"=� i r.) (-1
Date Installed "—t - Length of Field
Width of Field Depth of Field
ravel Bed Thickness
Square Feet of Absortion Area % Statndpipes Presence/N)
Depression over Field (YO)Date of Last Adequacy Test Jj a
Results of Last Adequacy Test i 7 3 5i? .
SEPARATION DISTANCE FROM ABSORPTION FIELD: 7
To Water -Supply Well zzjo �- To Property Line �U f
To Building Foundation To Existing or Abandoned System on
Lot ! �� /'� ; On Adjoining Lots
To Water Main/Service Line % D �"4 To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course 4e� /�
To Driveway, Parking Area, or Vehicle Storage Area 6z)
Comments
D. LIFT STATION
Date Installed
Sizellallons
"Pump On" Level ai'�
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
I certify that I havechecked, verified, or conformed to all MOA and HAA guideline:
inspection.
Cycles during Adequacy Test.
Signed N4a0aco_RRING
Company 17034 Eagle River Loop Road No. 204
Eagle River, A s a
Date �
MOA No. C_— 8-yys'
Receipt No. y %C% Receipt No.
Date of Payment
Waiver Fee: $
Amount: $ �'U. �� C� �� ` /000 Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
F - o
CHEMICAL &GEOLOGICAL LABORATORIES OF ALASKA, INC.
J .'' 5633 B STREET ANCHORAGE, ALASKA 99516 TELEPHONE (907) 562-2343
Aeo,.o,oaEs FEDERAL TAX IDN 92.0040440
ANALYSIS REPORT BY SAiiPLE for 41ork Order 11 16851
Date Report Printed: SEP 20 89 0 19:21
Client Sampie ID:L1 SARA DOG Cli.eni flame : S & S ENGR
PWSID :UA Client_ Acat : SNSENGP
Collected z hrs. P.0.1i NONE RECEIVED
Received SEP 19 89 0 17:00 hrs. Req 4
preserved Frith 1AS REQUIRED Ordered by
Analysis Completed :SEP 20 89 Send Reports to:
Laboratory Supervisor STEPHEN C. EDE US `! S ENGR
Released By A� C . a� 2j
Special
i ns LI uct:
Cheiflab Ref T: 7611 Lab Smpi ID: 5 Matrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE -N 1.7 mg/1 EPA 353.2 10
Sample
Remarks:
Tests Perforuiel See Special Instructieno Above WUna;ailable
ND= None Detected See :010 Remarks A:li=
NA= iiot Analyzed LT -Less Than, GT,=Gra ter Thar:
Time
APPLIr NT
FILLS OUT UPPER MA' -ONLY
Time
Property Owner •-
r�6, l�Jl,l (J'1
-
(`ir Cyr",C c/fie J
Phone
Mailing Address��(.;
> kjO'
Zip Code
k
Buyer
/
Inspector
Address
_
�`~J Zip `Code l��
Lending Institution
lit I t "� ' /(�- , j� l�
r� 0 1
Phone
`
yy!II
c% G, kl-
Addressp�Code
If0
Realty Co. & Agent
/s 1 N
1 � 1 i � i_!� t-, •-.. i�t��d. iX �� u � � �/� ; -
Phone
Address
�% %�1(� i/
f. Code
( ) DISAPPROVED
_J�j
r� ;`�
( ) CONDITIONAL APPROVAL'
Legal Description
DATE �'rl�
Street Location .%„
` 7 -, d .(A
Type �o esidence
-
Date Sewer Installed
Well To Absorption Area
K Single Family
❑ Multiple Family
>-•
No. of Bedrooms--
❑ Other
Water Su{fply
P (Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
❑ Community
For wells drilled prior to that dale, give well depth (attach log
if available).
❑ Public Utility
Sew�erD'sposal
Lf" Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
-
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time •,„y
Date
Date
Date
Date,,,/
Inspector
Inspector
Inspector
Inspector
Field Notes.
„ U01(Oa4l)Jd Ir.1u0WU0JiAU3
8 411ea10
„a6e.loy0liv yD Aa!Iedlalkin
W,.
`
08610 T ddM
c% G, kl-
If0
o M!2
( r,.-PPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE �'rl�
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size Wv�
Well to Tank
EXCAVATION
r OT109
Red Carpet/Great Land Realty
ATTEN`T'ION: Linda Ballard
P.O. Box 633
Eagle River, Alaska 99577
February 24, 1983
Dear Ms. Ballard,
Reference: Lot 35; Section 4; T15N; R1W
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1000 gallons. The seepage
pit was full of water and approximately 900 gallons had to be
removed prior to the start of the test. Approximately 900 gallons
of fresh water was then placed back into the crib and after a
period of 24 hours approximately 240 gallons had percolated out
of the crib.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence is currently functioning
adequately for only two bedrooms. It will be necessary to have
the absorption area upgraded before it can be considered adequate
for three bedrooms.
If we may be of further service, please do not hesitate to contact
US.
Sinr,6re/ly
A. SH.
/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
8f�'.0 IB!ix i. P.fil I. Tit`/-. h, f.'iA+J'.A
=3 DERARTME:N Entob P� _4 Apia-)
D. � MUNICIPALITY OF ANANCHORAGERAGE
�0 _���� OI- HEALTH AND ENVIRONMENT PR0TECT10N
82.5 1, Street, Anchorage, Alaska 99501. nn W/1-0 279-2511, ext. 224 or 2213 i0�
i ed ' Date Received! July -.2.5.1--1 97 7
41: Time �;o �� -- If 2: Time ) 1f 3 : Time �
Date _�� �i�F1� Date Date
InsP ]:nsh
-'0'"w Tnsp
RIPOUFST FOR APPROVAL 0,10 INDIVIDUAL SFWl3R AND WAT R FACILITIES,
a.. Lending Institution Request: First National BAnk of Anchorage
Mailing Address: Post Office Box 720 99510 — Phone: 276-6300/483
2, Property Owner: -David/Mary Arreola _ - Ption": 688-2456
Mailing Address: Post Office Box 784 Chugiak, 99567
3. I,c: clal Description: T15N R1W Section 4 Lot 35
4: Single Family Residence: (X)
Mu.li. i.pl.e Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
5. Well System: Individual Well (XAX Community/Public Sysl_-em ( )
Perm iL ; T` --------- Depth of Well -- lL�% Well Log on vile
Construction A R -b o-erll
� Bacterial Analy,,
6. Sewage Disposal. System: On --site sysLc,rn (X�xX
Public Utility ( )
Permit- #E Installed 41N._1 `t 196 V Installer
Septic Tank ,Size 0DC� ManufacLiuer
Absor��t ion Area 3��7 Soi-ls Rate Materia I.►�
Clo.mo
7. Distances: Well to Septic Tank ---- --- --` to AbsorpL_i.on Area
i.o Sewer. Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of Izealth and Environmental Yr.otect..ion
Request for .Approval of lndivi.dual. Sewer and Wate- FaciliL:ics
Legal Description: T15N R1W Section 4 Lot 35
Comment s :
-7p.i_
A._Ffadavit Attached: ( )
0
j--
Letter
Attached: ( )
Approved:! `!`'�_A D z-
�..
Disapproved:
Department Worksheet:
Date:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CON V X
2.
Property Owner:_ David
& Mary Arreola
Mailing Address: P• 0.
Box 784 Chuaiak
AK
Day Phone:
688-2456
3.
Name of Buyer:_ Richard & Mary Rochin
Mailing Address: P. 0.
Box 735 Chugiak
AK
Day Phone:
688-3245
4.
Name of Lending Institution:
First National Bank of
Anchorage
Mailing Address:
P. 0. Box 720
Phone:.
276-6300 ext 483
5.
Name of Realtor or Agent:
Alma M. Werre
Mailing Address:
P. 0. Box 1065
Eagle
Phone:
694-9524
River
6.
Legal Description:_
Lot 35, Sec 4 T 15 N,
R 1 W, S.M.
Location:
Chugiak Alaska
One Lot West of Homestead Road
7. Type of Facility to be Inspected: Existing Single Family No. Bdrms. 3
8. Water Supply
Type of Supply
s
Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
72-003(3/76)
Individual (on-site) X
Marie Iiams 7/21/77
Ja2a hci�o�
R�§\ A
0, ., ( omy) I
JAA 4 ol., St)
MUNICIPALITY OF ANCHORAGE
A DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASE REVIEW WORKSHEET
CASE NUMBER:
S-8773
DATE RECEIVED:
January 3, 1989
COMMENTS DUE BY:
January 12, 1989
SUBDIVISION OR PROJECT TITLE:
Lot 1A Sarandog Subdivision �-
( ) PUBLIC WATER AVAILABLE
( ) COMMUNITY WATER AVAILABLE\
( ) PUBLIC SEWER AVAILABLE
r
COMMENTS:
�y
t
w_mn In— corm
PRELIMINARY PLAT APPLICATION OFFICE USE
• -�
Municipality of Anchorage M
DEPARTMENT OF COMMUNITY PLANNING RECD BY:
P.O. Box 6650 VERIFY OWN: 4.
Anchorage, Alaska 99502-0650
A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded bw1(t.•-�_.,
^c
•• A
0. Case Number (IF KNOWN) 1. Vacation Code
r
2. New abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34).
f�p
3. Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BILK 3 LOT 34) full legal on back
page.
4. Petitioner's Name (Last - First)
5. Petitioner's Representative
Address 2 3S t' -A57- a 1,11v� Address �'0 ` 4 4A �l/ Zoo
City State " r' ` City / c State
Phone No.S61���DO� Bill Me Phone No. �!` r r2 Bill Me.
6. Petition Area 7. Proposed 8. Existing 9. Traffic 10. Grid Number 11. Zone
Acreage Number Number Analysis Zone
Lots Lots
€t 2. 3 3 fi, X42 F3,
�V v�
12. Fee $� 13. Community Council _
B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to
subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment
of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it
does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's
costs to process this application exceed the basic fee. I further underst at as gned hearing dates are tentative and
may be have to postponed by Planning Staff, Platting Board, Planni Commissi , or the Assembly due to administrative
reasons.
Date:
Signa
'Age is rovide written proof or authorization.
20-003 Front (4t85)
e
5. Petitioner's Representative
Address 2 3S t' -A57- a 1,11v� Address �'0 ` 4 4A �l/ Zoo
City State " r' ` City / c State
Phone No.S61���DO� Bill Me Phone No. �!` r r2 Bill Me.
6. Petition Area 7. Proposed 8. Existing 9. Traffic 10. Grid Number 11. Zone
Acreage Number Number Analysis Zone
Lots Lots
€t 2. 3 3 fi, X42 F3,
�V v�
12. Fee $� 13. Community Council _
B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to
subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment
of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it
does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's
costs to process this application exceed the basic fee. I further underst at as gned hearing dates are tentative and
may be have to postponed by Planning Staff, Platting Board, Planni Commissi , or the Assembly due to administrative
reasons.
Date:
Signa
'Age is rovide written proof or authorization.
20-003 Front (4t85)
C. Please check or fill in the following:
t. Comprehensive Plan — Land Use Classification
Residential Marginal Land ,— Alpine/Slope Affected
Commercial Commercial/Industrial Industrial
Parks/Open Space Public Lands/Institutions ,. Special Study
Transportation Related
2. Comprehensive Plan — Land Use Intensity
Special Study
3. Environmental Factors (if any): ���
a. Wetland
1. Developable
2. Conservation
3 Preservation
Dwelling Units per Acre —tom
Alpine/Slope Affected
b. Avalanche _
c. Floodplain _
d. Seismic Zone (Harding/Lawson)
D. Please indicate below if any of these events have occurred in the last three years' on the property.
Rezoning Case Number —
Subdivision Case Number S-7-763 O K 944
P �z �
Conditional Use Case Number —
Zoning Variance Case Number
Enforcement Action For —
Building/Land Use Permit For
Army Corp of Engineers Permit
E. Legal description for advertising.
Z O T /,'9 5'/-Q
H DO G- S,(� — G L Q L. 0 T
,5-4,e,97
1,5-4,e,97
A�) R / w -51/ �1 _ 6 .57 /-R
�
F. Checklist Waiver
30 Copies of Plat
Reduced Copy of Plat (8112 x 11) n
Certificate to Plat/(
Fee
opo Map 3 Copies
J
Soils Report 4 Copies Q
Aerial Photo
Housing Stock Map
Zoning Map
Water: Private Wells Community Well
Public Utility
wer: '-Private Septic Community Sys.
Public Utility
20-003 Back (4185(
GLACIER ROAD -
r ✓
I � I
LOT IA
2D E- FEL
3ex1.
YARNOT AV
EDED, TED, TTF5 'LAT
ED II
xOTR -o eE ANT _GORE. m EDP LADe wT3 a e, s R_HOO. EJED i84.3e4)
bR. [be 1W D. Lfl and D Y Cre n
D{
aoe aids-xhwll vee' d' be O 0 6 S
.aau,-'
n /< IT,, 1.. n a[e
bd orse D fm cvneav eSes by _.—.
N . nL be,abV x/a
PLR. A>c'90'+A(
p. :NEred by 1. M ry Lel PbR1g RVID�n[y
diie c"L ]ay Lsl'!n , 1972
G
c"I'll, OF CNNERSH/P and OEOICA i/Of
_ rre/np/d [M1e nere[n spxdeue�o¢nv m:em[
u y mae
✓mpertv oavnbelheieon. [ p..a./ hga0y eetlie3 [e m lb.. Muni ma....
ae dep¢.2G 4 I 1, ley4 m:3tll er. (iio
o"'DE a deb [ Aar
/k[D"<a"T I Ir �nele {' lopste L e
O.5 ¢I/o/v os fie {o� bapw
9 le
vt[ of/fic _
a upo y c
e(a.. r✓px... ., D:N bV f[e!dureaoa!q.
DLEY,. '.enan[aoeaa[nx
2 ne a5x oehb
auholmM1'E. eade
Aa oel e� enla[csvesrve ownersol lhrs proparu.
_.< ee_n3 � 89-5c
' °
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