HomeMy WebLinkAboutMCGILLIVARY LT 166A�" � t t; �
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Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241108 PID Number: 018-282-24
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade
Name
NIK OPANASEVYCH
ABSORPTION FIELD
❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.8 GPD/SF
9.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft
Gravel depth beneath pipe
7.5 Ft
Subdivision Block Lot
]Fill
MCGILLIVARY LT 166A
added above original grade
4 Ft,
Gravel length
50 Ft_
Township Range Section
Gravel width
2.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
0
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
750 Ft z
Ft.
Well
1001+
1001+
50'+
TANK X Septic 01 S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
GREER/ANCH TANK. 1500 Gal.
Surface Water
100'+
100'+
Material
Number of compartments
Lot Line
10'+
10'+
NA
PLASTIC
2
Foundation
10'+
10'+
LIFT STATION
Manufacturer
Capacity
Remarks
ANCH TANK
1500 Gal.
Alarm location
NE CORNER
Electrical installed by
BRICKS ELECT.
Installer
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
MIKE N ANDERSON PE
Drainfieid 3034 COIMT3034
Inspector MIKE N ANDERSON PE
BENCH MARK (Assumed elevation) 100 ft
Ins daction
1p 9119124 9/23/24
Location and description
tes: 2"�
TOP OF MH LID
3`d a'^
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stamp
�?�''
Conditional Approval: Date
�b ��•
i *.'49TH .., .t
MICHAEL N. ANDERXid'•�r�1'
Septic Syste
Approved Date
CE 1 �Z.
�fi��" ���'•.
cis%4.
No. this approval does not include well permit requiremen s,
kRvv "'\7
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Cogger, Benjamin M.
From:
Walters, Michael S.
Sent:
Tuesday, November 5, 2024 7:11 AM
To:
Cogger, Benjamin M.
Subject:
RE: McGillivary Lot 166A
Attachments:
MCGILLIVARY LT 166A.pdf
Ben,
1. The owners are put on notice the shed, fence, or other structure is an unpermitted encroachment into
the Utility, Public Use, or Drainage Easement, and ROW is not enforcing it at this time. Should the
encroaching item(s) need moving or the owners want to replace them, the final location needs to be out
of the easement(s).
If this right of way reserve is ever utilized, there is adequate room to support a road structure. No encroachment
permit will be required.
Thank you for the opportunity to supplythis review.
Michael S Walters
Senior Plan Reviewer
Right of Way Section
michael.waltersCcDanchoraoeak.aov
Office: 907-343-8226
Cell: 907-727-7637
Fax: 907-249-7910
#ANCWORKS!
An online tool for Anchorage
From: Cogger, Benjamin M. <benjamin.cogger@anchorageak.gov>
Sent: Monday, November 4, 2024 5:01 PM
To: Walters, Michael S. <michael.walters@anchorageak.gov>
Subject: McGillivary Lot 166A
Mike, here is the record drawing and as -built survey for this property, please let me know if you have any concerns.
Ben Cogger
Municipality of Anchorage
On -Site Water and Wastewater
907-343-7905
AK-CESCL
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP241108
Work Type: WellSeptic Renewal
Tax Code Number: 01828224000
Site Legal Address: MCGILLIVARY LT 166A G:3135
Site Mailing Address: 14990 LOC LOMAN LN, Anchorage
Owner: OPANASEVYCH NIKOLAY
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
1V» S
Q
t�CI)81'Cll1C'11C
Lot Size in Sq Ft:
Total Bedrooms:
5/29/2024
5/29/2025
53827
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Rz-Geive"y:
Issued By:
Date:
Date: 2� 2
4
MUNICIPALITY OF ANCHORAGE R05 H
arra;
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section �-� Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 018-282-24
Property owner(s) OPANASEVYCH
Mailing address 14990 LOC LOMAN LANE, ANCH
Site address SAME
Day phone
Legal description (Sub'd., Block & Lot) MCGILLIVARY LOT 166A
Legal description (Township, Range & Section)
Lot Size 53827 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(N all that apply)
Absorption Field
0
Initial 0 Single Family (SF) 0
Septic Tank
0
Upgrade❑ (w/wo ADU)
(D) El
Holding Tank
❑
Renewal 1-1Duplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
0
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
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: 42.32 Waiver Fees:
Date of Payment:
Receipt Number:
Permit No. 0S/0 221 11010
Date of Payment:
Receipt Number:
Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
May 28, 2024
Municipalities of Anchorage
On-Site Water and Waste Water Section
4700 Elmore Rd
Anchorage, Alaska
Phone 343-7904
Re: PERMIT RENEWAL
Legal: MCGILLIVARY LT 166A
To whom it may concern:
This is a request for a permit renewal for the above referenced lot. Nothing has
changed for the design including soils or water issues. The septic installation was
delayed due to placement of the house foundation.
This new septic renewal will not impact any of the neighbors or encroach on any
wells, septic or open water issues.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241108, Deb Wockenfuss, 05/29/24
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
tom' 4700 Elmore Road
P.O. Box 196650 `
5a [rr
Mark Begich Anchorage, AK 99507
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW05nv 193 Date of Issue: �3a/22
Parcel Identification Number: 018 -2.$2-2.1
Legal Description Property Owner Name & Address:
�il(oloa� C,�a.no..,edy4h
McG�llivory LT 14&A&:31391yg90 Lot. L.orwvn Ln
Pump Installation Date: 5 -
Pump Intake Depth Below Top of Well Casing:168,sfeet
Pump Manufacturer's Name: Myf r-5
Pump Model: UFooz—IZ-10H-D2 ZWn> Z30v (0042
Pump Size 1 hp Ipym
Pitless Adapter Burial Depth: g•9 feet I
Pitless Adapter Manufacturer's Name: �bejf B 10
Pitless Adapter Installer: NAL
Well Disinfected Upon Completion? ® Yes 1❑ No
Method of Disinfection: �� �Or�Re T I let,
Comments:
Pump Installer Name: Johnny Kay
Hefty Drilling, Inc.
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Well Log
Permit Number: # OSP221483 Date of Issue: 12/30/22 Parcel Identification Number: 018-282-24
Date Started: 11/29/23 Date Completed: 11/30/23 Is well located at approved permit location? Yes Q No ❑
Legal Description: McGillivary LT 166A G:3135
Property Owner Name & Address: Nikolay Opanasevych
14990 Loc Leman Ln
W1
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Casing Stick Up
0
2
Sand & Coarse Gravel
2
13
Sand & Gravel
13
30
Coarse Gravel w/Sand
30
35
Boulder
35
37
Gravel & Sand
37
49
Boulder
49
51
Boney Gravel & Sand
51
58
Boulder
58
61
Gravel
61
76
Fine Sand & Gravel
76
82
Silt & Gravel
82
106
Wet Silt & Gravel
106
110
Silt & Gravel
110
145
Wet Grey Clay & Gravel
145
178
Wet Silt & Gravel
178
190
Gravel w/H20
190
194
Bedrock 1194
195
Water Sample Results:
Arsenic: ug/L
Nitrates: mg/L
Total Coliform Bacteria: colonies/100mL
Method of Drilling U air rotary ❑ cable tool
Casing type: A53B Steel
Wall Thickness: .250 inches
Diameter: 6 inches Depth: 194
feet
Liner Type: N/A
Diameter: — inches Depth: —
feet
Casing stickup above ground: 2
feet
Static water level (from ground level):
50 feet
Pumping level: — feet after
— hours pumping —pm
Recovery Rate: 50+ gpm
Method of Testing: Air Lift
0 Open End ❑ Open Hole
❑ Screened Start 0 feet Stopped 194 feet
❑ Perforations Start feet Stopped feet
Grout Type: Bentonite Volume: 2 Bags
Depth: 20 Start 2 feet Stopped 22 feet
Well Disinfected Upon Completion? Yes No
Method of Disinfection: Tabs Comments:
Well Driller: donnnyKay
Company: Hefty Drilling, Inc.
Mailing Address: P.O. Box 112130 Anch., AK 99516
Attention: The well driller shall provide a well log to the
On-site Water and Wastewater Section within 30 days of
completion.
!No� MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
- PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
.`�`�� http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221483
Work Type: Septic Initial
Tax Code Number: 01828224000
Site Legal Address: MCGILLIVARY LT 166A G:3135
Site Mailing Address: 14990 LOC LOMAN LN, Anchorage
Owner: OPANASEVYCH NIKOLAY
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
R�1,ent
N
c, ter.
I� J
De pa i, tnien t
12/30/2022
12/30/2023
53827
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy CJI Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
ReceivvxkSy: _ S5EAeCA ft? A-ke- Xj /`170e11_t_or\ Date:
Issued By: Date:
2A "2 2
4
MUHMP UTY OF ORAGE
Development Services Department _ Phone: 907-343-7904
On -Site Water & Wastewater Section ' -- Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 018-282-24
Property owner(s) NIC OPANASEVYCH Day phone
Mailing address 1120 HUFFMAN ROAD SUITE 24-497, ANCHORAGE, AK 99515
Site address LOC LOMAN LANE, ANCHORAGE AK
Legal description (Sub'd., Block & Lot) MCGILLIVARY
Legal description (Township, Range & Section)
Lot Size 53,827 Sq. Ft. Number of Bedrooms 4
LT 166A
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
�
Initial F
Single Family (SF) Q
(w/wo ADU)
Septic Tank
0
Upgrade ❑
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
X
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
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: 5q5f aaS' : $a -"'O
Date of Payment:
Receipt Number:
Permit No. 121 c% 3
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Dec. 28, 2022
Municipalities of Anchorage
On-Site Water and Waste Water Section
4700 Elmore Rd
Anchorage, Alaska
Phone 343-7904
Re: New septic & well permit
Legal: MCGILLIVARY LT 166A
To whom it may concern:
This is a request for a septic and well permit on the above referenced lot for a new
4-bedroom house. A single test was excavated and found silty sand SM for the
entire 17 foot depth. No water was observed during excavation or after the 7-day
monitoring period. The perc was measured at 12 minutes per inch. A new STEP
tank has been designed to allow for a full basement. The proposed septic site is flat
but a steep slope is located over 50 feet away, see the site plan, which will not impact
this new system.
This new proposed septic design will not impact any of the neighbors or encroach on
any wells, septic or open water issues.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221483, Deb Wockenfuss, 12/30/22
SEPTIC FIELD SECTION
DESIGN CRITERIA:
8.0' EFFECTIVE
4 BDRM X 150 = 600 GPD
SOILS = 600/0.8 =750 SQ FT REQ'D
750/2(8) = 47', USE 47
2.0' WIDE
47' LONG
(1) TRENCH
10.0' DEEP
-17'
(TH#1)
-1.0'
SM
OR 2.0'2.0'
-10.0'
-2.0
MOUND OVER
FILTER FABRIC &
SEWER ROCK
3,3(:
GRADE
1"=200'
PROPERTY LINE
PROPOSED
DRAINAGE FIELD 8.0'PROOSE NEW
WELL 100'
RADIUS
-LOC LOMAN LANE-PROPOSED
HOUSE
SCALE:
DJRDRAWN:
DATE:
MCGILLIVARY LT 166A
Anchorage, Alaska
NIKOLAY OPANASEVYCH
12/2/2022
NO WATER OCT 2022
INSULATION
+2/(6#
SEPTIC
SEPTIC
SEPTIC
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221483, Deb Wockenfuss, 12/30/22
1"=50'
PROPERTY LINE
PROPOSED
NEW HOUSE
PROPOSED
WELL 100'
RADIUS
WELL
SCALE:
DJRDRAWN:
DATE:
MCGILLIVARY LT 166A
Anchorage, Alaska
NIKOLAY OPANASEVYCH
12/2/2022DRIVEWAYNEW 1500 GALLON STEEL STEP
TANK, 10' FROM THE
FOUNDATION
MT
MT
TH#1
SEPTIC
SLOPE
>
3
0
%0 SLOPEFCO
TCO
APPROX.
SHOULDER OF
45% SLOPE
PROPOSED WELL
10' T&E EASEMENT33' EASEMENT FOR ROADWAY & PUBLIC UTILITIES
SEPTIC
SYSTEM > 100'
FROM
PROPOSED
NEW WELL ON
THIS LOT
10' ELE
C.
E
A
S
E
M
E
N
T
SECONDARY TRENCH, 30' LONG
X2' WIDE X8' DEEP W/ 5'
EFFECTIVE, APPLICATION RATE
OF 2GPD/SF ADVANTEX, NEW
TEST HOLE REQ. PRIOR TO
INSTALLATION
CO
TCO
EXISTING
SYSTEM,
MAINTAIN 20'
SEPARATION.0 SLOPE0 SLOPE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221483, Deb Wockenfuss, 12/30/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221483, Deb Wockenfuss, 12/30/22
MUNICIPALITY OF ANCHORAGE
4�
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel 1. D. 018-282-24-000
Expiration Date:
Legal description MCGILLIVARY LT 166A
Site address 14990 LOC LOMAN LN Anchorage AK 99516
Current property owner(s) OPANASEVYCH NIKOLAY
10/15/2025
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
z
Original Certificate Date: 11/5/2024
s Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovaLJune 2022
MUNICIPALITY OF ANCHORAGE
V�
Development Services Department_ Phone: 907-343-7904
5
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 018-282-24
Complete legal description MCGILLIVARY LT 166A
Location (site address) 14990 LOC LOMAN LN,. ANCH AK
Current property owner(s) N I K OPANASEVYCH
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel❑ Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested:❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 12 0
Date of Payment
COSA# 453
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: MCGILLIVARY LT 166A
ParcellD: 018-282-24
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
H Well log is filed with Onsite (or attached)
Date drilled 11/30/23 Total depth 195 ft
Cased to 194 ft
Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA NEW
Static water level at beginning of test 50 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NEW
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) NEW
0 ALL standpipes present per record drawing
Total measured depth from grade 9.5 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ NIA — pressurized field.
❑ Per record drawings, field is insulated.
Q Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
COSA Checklist June 2022
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 0 No
9 Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by MNA
Date 10/15/24
C. LIFT STATION
H Required maintenance completed
Age of lift station NEW years
Lift station material PLASTIC
Comments:
Adequacy test date NEW
Results Q Pass
Fluid depth prior to test _ in
Water added _ gal
New fluid depth _ in
Elapsed time _ min
Final fluid depth _in
Absorption rate _ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 90 in
Effective depth used 0 in
Effective depth remaining 90 in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
Qo Yes if No ft E Yes if No _ ft
Neighboring Tank > 100' ❑� Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft
Absorption Field on Lot > 100' ❑� Yes if No ft Holding Tank > 100' FE Yes if No _ ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑� Yes if No _ ft
Fa Yes if No _ ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'❑ Yes if No _ ft Q Yes if No _ ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑E Yes if No _ ft Surface Water > 100' 9 Yes if No _ ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
DYes ifNo_ft
0 Yes if No _ ft
Q Yes if No _ ft
FC Yes if No _ ft
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
[EYes ifNo_ft
9 Yes if No _ ft
If tank or field is under driveway comment below
G. CERTIFICATION & 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 Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm _1\41dy.r C /V e�Ad er4cm rF't
Engineer's Printed Name �7ahnE,
COSA Checklist June 2022
Phone 727-8864
Date
.:.
..........
s! : MICHAEL N. AK0ik5C 1
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THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT
ARE NOT SHOWN HEREON, UNLESS NOTED.
NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
GRAVEL DRIVEWAY
WEST 149.23
THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE
OWNER OFRECORD AS
OF THEDA TE OF THIS SURVEY
ANYUSE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
FINAL STRUCTURE AS BUIL T
AS-BUILTSURVEY I" =30'
NO CORNERS SET THIS DATE
/HEREBY CERTIFY THA TI HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT166AMCGILLIVARYSUB. (PLAT99-21)
A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENT S SITUA TED THEREON ARE WITHIN
THEPROPERTYLINESANDNO VISIBLEENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED ATANCHORAGE,ALASKA THIS 18TH DAYOF
OCTOBER 2024
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
16162 239-29 PP3-sez5