HomeMy WebLinkAboutSEACLIFF BLK 3 LT 12Aeacliff
Block 3
Lot 12A
#011-221-39
Municipality of Anchorage Page I of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
900242-
Permit Number: PID Number:
Name:
P-" - C
Wastewater System: ❑ New XUpgrade
Address:
Z l
ABSORPTION FIELD
Phone:
No. of Brooms:
❑ Deep Trench El Shallow Trench Bed 11 Mound ❑Other
LEGAL DESCRIPTION
Soil Rating: t.2
Total DeoSh from original grade:
GPD/Sq. Ft.
Lot: Q. c✓ Block: Subdivision:
2
Depth to pipe bottom from original grade:
3,57
Gravel depth beyeath pipe
I
r ` 4T W"
Ft.
Ft.
Township: `` rr
Range:
'+K/.
Section:
Fill added above original grade:
Gravel length: p 1
i
14
I Ft.
t Ft.
WELL: ❑ New ❑ Upgrade
Gravel depth:
Number of li es:
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C : Tot e pth:
Cased To:
Total absorption area:
S D
Pipe material: ' L
ASTM
Ft.
Ft.
/ SO. Ft.
3017
Driller: Date Drilled:
Static Water Level:
Installer: t
Date insta ed:
Ft.
Yield:
Pump Set at:Casing
Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station Tank
Sewer Lines
�_, �
P'(t�f t AT1v ,{Fs
' Qb 0
Well
Material,
Number of Compartments:
Z
Surface
tv
LIFT STATION
Water
Lot^
n
fj
�O 1
Size in gallons:
Manufacturer:
Line
4
Foundation
ZZ/
—1 W)
"Pump on" level at: Pu off' level at: 77gh
water alarm at:
Curtain
N4
Pump Make & Model lectrical Inspections performed by:
Drain
Remarks:
BENCH MARK
Location and Description:
Assumed Elevation:
EIf RV11 OP j �L
m� '8 2t 0
�rv.e..° °aema ;t rrvana`ea°aa°e�
Inspections performed by: t ates: 1st
e
p
W�G Q1G� 2nd
d, ......;.t „..e.°,�'
��°� i M °,.. W. PEARSOIV as 4�
�,°. GE• - 7760 '� ��
Department of Health and Human Services approval
CoQ
Reviewed and approved by: - 1ytLg Smclat Date: 9I
TM� ss.�..
72-013 (1/91) MOA 25
Permit No. 9 dO2�2
Page 10 of 110
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: 5C--4 C -W f=f—S.)pts-IZA i QtAGt'_3 PID No.: Olt -2-2-1 59
DIS�RNC-
-rn
-
I
26
ST�z
3l
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33
610
72-013 A (2/91) MOA 26
�1 8 MARK V. PEARSON gf V�
CE - 7760 e
Municipality ®f Anchorage } j
J rl�
Department of Health and Human Services1r15
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 10, 1991
James Mc Carron
9321 Jaclaire Lane
Anchorage, Alaska 99502
Subject: Lot 12A Block 3 Seacliff Subdivision
Permit #900242, PID #011-221-39
The subject permit, issued by this office for a single.family
well and/or on-site wastewater system has expired as of December
31, 1990.
A new permit must be obtained from this office for a well and/or
on-site wastewater system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation. All inspection reports must be
submitted within 30 days of construction completion.
When applying for a new permit, -the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions,
Since ly
John m:L P
Prog am Mana er
On-site Services
JW/1jm:200
enc: Copy of Permit
please call this office at 343-4744.
"Kids Are Our Future"
MUN1CjPALlTY O11 AA! CHu 1 j to C...;E
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343~4720
OTE SEWER PERMlT
|'ermit Number: 900242 Upgrde LL�, �La�,q a
Date Issued: 08/14/90 En�ineer Designed
Owner Name: JAMES MC CARRON
Day Phone:
Owner Address: 9321 JACLAIRE LN,
696�170O
ANCH; AK 99502
Parce� ld: 011~�21-39
Loi 1.:ga1:
lock: 3
Section: 3 Township: 1201 Range:
4W
Lot Size 13195 (sq,Nt_ or acres)
Max Bedrooms: ,This Permit: 3 Total Capacity:
3
3EPTIC TANK: Minimum tota1 septic tank capac1ty:
1000 c!allons , Each septic
Lank must have ai least 2 compartmenis" Depth to
top of septic tank(s) < 4.0
�eeL requires insu1ation over tank(s>,
l/�E 8ED MUST BE INSTALLED AS SHOWN ON THE ENGINEER'S
DESIGN
DATED U/1/90" DHIS MUS[ BE NOTIFIED PRIOR TO ALL
INSPECTIONS. A
i lF^[ SlATION lNSTALLAT[ON REQUIRES AN ELECTRICAL
lNSPECTICAN. THE
�X}GTlNG SEEPAGE PIT MUST BE PHOPERLY A8ANDONED.
THIS PERMIT IS
FUR A 3 �EDRUOM SINGLE FAMILY RESIDENCE ONLY, AND
EXPIRES ON
12/31/90.
l CERTIFY THAT:
am familiar with the requirements for on-site
sewers and wells as set
the Municipality Anchorage (MOA)
and the State of Alaska.
�orth by of
2. I will install the system in accordance with
all MOA codes and regulationmi
and in compliance with the design criteria of
this permit"
3. I will adhere to all MOA and State of Alaska
requirements i or the sot back
distances from any existing well, wastewater
disposal system or publzc
sewerage system on this or any adjacent or nearby
lot,
4. l understand that this permit is valid for a
maximum o� 3 bedrooms" I
also undersLand that the capacity o� the total
system is 3 bedrooms and
any enlargement w�Jl require an additional permit,
Signed:
lssued
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e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: .:9�/VV`2-S L(�f.®,%�✓V� DATE PERFORMED: IZ f L Q
LEGAL DESCRIPTION: J-rr--�- �l="f`I`- S I , L tZl� / Township, Range, Section:
SLOPE SITE PLAN
DEPS ! _ !I b�G�� �G
2-
3-
4 34
5 .7
6
7
v
8
c�
10
:O
11
12 0
It
13
14
15
16
17
18
19
20
t'e'vvi.)
L9
WAS GROUND WATER t, t�
ENCOUNTERED? I�
s
IF YES, AT WHAT 0
DEPTH? P
E
Depth to Water Aller G
Monitoring? Date: I t
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
11 f TEST RUN BETWEEN FT AND ( FT c ! t
COMMENTS �7UIlS .7�—l�I (ifSULt�r TZ'� (qj`L(z;-S!VRfZ Sh y �i'h a'l 6 thotP i`C_CQ.S�i1�J�C ,
►s (I'L�SS��g�Y���-i=s��s� ,►yIz'c� t� tglu�'= s`7usF .
PERFORMED BY: ICERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: j't ( ci
72-008 (Rev. 4/85)
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 011-221-39 Expiration Date:
1. GENERAL INFORMATION
Complete legal description SEACLIFF BLOCK 3 LOT 12A
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
9321 JACLAIRE LANE *ANCHORAGE AK
CORRIENNE YOUNG Day phone 887-9032
9321 JACLAIRE LANE *ANCHORAGE AK
Day phone
Single Family (w/wo ADIJ) a
ij
ay, Fs zq r_1=
F-]DuplexLa
❑ Multiple Dwellings (Single Family and/or Duplex
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
N
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
E
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: I �/A _4Distance:=
Received by:- ` L �✓' ' �`�'/ Date:
f,.
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ` q6
Date of Payment �A�� Ll, -3
Receipt Number
COSA# (JcSct3 Kp��
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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
d in the Certificate of
shows that the on-site water Supp/y and/oures er wastewater disposal sOn-Site Systems Approval ystem is (are) safe, e, functional an
for the number of bedrooms and type of structure indicated herein. I further verify that based on Guidelines for this application,
information obtained from the Municipality ofAnchorage files and from my investigation and t diode the on-site wafer 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 Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK 99507
Engineer's 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 & Regulations. The reported results described the performance of the
system under the conditions encountered it 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 do not guarantee conditions are outside the control of the evaluator of the system. Satisfactory lest
the
there results e no hidden defects toreencroachmentsperformance f GEG, LrTD. can nor dothey
therheoe not provide
that
operationalany warranty or future estimate of howlong the system will continue to meet the
The
the D
the sole benefit of the orequirementwnes Ofrlsted abo�e. AOny reliance upon or usent Ofreport this sport for any 6
other person or party is not authorized, nor will it confer any legal right whatsoever. G
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for
bedrooms.
Disapproved.
Phone 337-6179
Date 1 7, /10 /?
o OF q" pQ
T �C
..
. ............
f L`Y Gornes
CE—(
G
r
�.. 43
n�c000
Prof essio°°� o
tOFtfAA%
Conditional approval for
bedrooms, with the following stipulations:
ON-SITE
WATER AND
WASTEWATER
C Original Certificate Date: !
he nicrpality or._AIchorage Develop,emtServices Division (DSD) issues Certificates of On -Site Systems A _l
)on the representations given in paragra h 5 b
responsible for errors or omissions !n the Professional engineer's work.
y an independent professional civil engineer registered in the State ofAlOaska.basetloniy
ie Municipality of Anchorage is not
ATTCHMENTS:
COSA Checklist
Septic System Advisory Nitrate Advisory
Well Flow Advisory Arsenic Advisory
Other
tuns
If more than 7 septic system is on the lot:
COSA Checklist # of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: SEACLIFF• BLOCK 3, LOT 12A Parcel ID: 011-221-39
A. WELL DATA
Well type A
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
If A, B, or C provide PWSID# 210485 Well Log (YIN) _
_ Sanitary seal (YIN)_ Wires properly protected
Cased to ft. Casing height (above -9`6
FROM WELL LOG
Coliform colonies/100 ml. Nitrate
ft.
ATI
mg./L. Collected by:
g.p.m.
in.
A Ic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA *FCO IN CRAWLSPACE
Tank Type/Material SEPTIC/STEEL Date installed 8/21-22/90
Tank size 1000 gal. Number of Compartments 2 Cieanouts (Y/N) YES
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping C ( Pumper 5 u c S it ,x'117CD
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 8/21-22/90 Soil rating (g.p.d.lft2or /bdrm 0.8 System type BED
Length 30 ft. Width 19 A. Gravel below pipe 1.0 ft.
Total depth *5.83 ft. Eff. absorption area 570 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 12/6/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test E in. Water added 1040 gal. New depth 0_5 in.
Elapsed Time: 121 min. Final fluid depth E in. Absorption rate >= 450+ g,p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump ofr' level High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAM station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
areas
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1 oo'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 1o'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date _ _ l 4", 413
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division = '
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ;2 21- 3 9 COSA # O G 0 3 3
Expiration Date:
GENERAL INFORMATION
Complete legal description Sei t l; f F Q lack 3 Le} 12.A
Location (site add ress) 93ZI ixe-laire- Lean e.
I
Current Property owner(s) Pais/ 11C Csrron Day phone Zy3 - S 5Z0
Mailing address `13z1 c).clitrt Lnnry Anci+oraje. AK. 99502 I
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
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 Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer -registered in the State of Alaska -Certificates of On -Site Systems -Approval are -required for -the lransferof
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems 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 sample results. (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 Certificate of Onsite Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SDur1jMA £ntiineertinq
Address 203 W.ISI'SF_�2� A,u�.n5e Ak g950f
Engineer's Printed Name Lars Snug %Li aN�
S. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Phone Z1i-3414
Date 6 2
t
�• C:,
A## ✓7 S4UR.�`D
Conditional approval for bedrooms, with the following stipulations:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate-Adviso the
By: Original Certificate Date: / ' DIG
(Rev. HAS)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Seu-litt Qlock 3 W 12A Parcel ID: 3
A. WELL DATA
Well typeFM iL
Date completed _
Total depth � ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (YIN)=
Cased to — ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
ft.
Coliform colonies/100 mL Nitrate — mg/L
Arsenic: ppb date of sample:
Well Log (YIN)
Wires properly protected (YIN)
Casing height (above ground) I'� in.
AT INSPECTION
ft
g.p.m.
Other bacteria colonies/100 mL
Collected by:
B. SEPTIC/HOLDING TANK DATA _
TankType/Material o/AP (Arik Sea Date installed $'/-4190
Tank size 1000 gal. Number of Compartments Z Cleanouts (YIN)
I
Foundation cleanout (YIN) y Depression over tank (YIN) N High water alarm (YIN)
Date of pumping 8126 Lo�p Pumper Anc6CompoolPW'n
C. ABSORPTION FIELD DATA
Date installed 8 21 0 Soil rating (g.p.d./ft2 or ft2lbdrm)I•3 System type Re
1
Length I q ft. Width 30 ft. Gravel below pipe • 5 ft.
Total depth' ft. Eff. absorption area aft2 Monitoring tube 'l!_ Depression over field Al
Date of adequacy test Results (Pass/Fail) F405 For 3 bedrooms
Fluid depth in absorption field before lestz- in. Water added gal. New depth a in.
Elapsed Time: 4— min. Final fluid depth 7_ in. Absorption rate >= 150. g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) Af o If yes, give dale
D. LIFT STATION
Date installed Size in gallons nhole/Access (Y/N)
"Pump on' le _ in. `Pump off" level _ in. High water alarm at in.
D CYCIOA40sted Mee rm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Animal containment areas Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r t /
Building foundation > S Property line >/0 Absorption field > S
Water main wo r Water service line > 10 r Surface water N• 0
Wells on adjacent lots 7 /0o
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r
Property line t0 Building foundation ? /01 Water main i 10=
. r
Water Service line 10 Surface water W. 0 - Driveway. parking/vehicle storage
Curtain drain Al. 0. Wells on adjacent lots 100 =}
F. COMMENTS
G. ENGINEER'S CERTIFICATION ' .OF A4gs''I
1 certify that 1 have determined through field inspections and y•'
review of Municipal records that the above systems are in :49TH10
conformance with MOA COSA guidelines in effect on this date. 0 • " ^" r _ • • /
10
Engineer's Printed Name _ Lif5 Spmtbland %/ �: LABS E. ruFKL ASD. -W i
I I 1
Date 0 22 0(, __ 1 ��•'• �)1�oj, •i�V�
COSA Fee $ Z-� 3 O
Date of Payment L7—
Receipt Number
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
it MSR RR1.1d
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E. Johns, Jr.
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Professional Land Surveyors
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PLOT PLANS i1 LOT SURVEYS
THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
IT IS
CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS.
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. DAILY. SNOW
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED StIBDIVISION PLAT. All DISTANCES
UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
FOR THE COST OF THE SURVEY.
THE SURVEYOR TAKES STIED STANCES PREVAIL OVER SCALNTRANSACTION REPRODUCTION MAYSCAUSE ERRORS IN SCALEY