HomeMy WebLinkAboutAERO ACRES BLK 1 LT 2Aero Acres
Block
Lot 2
#010-185-05
Municipality of Anchorage
Community Development Department
On -Site Water & Wastewater Program
4700 Elmore St. ■ P.O. Box 196650 ■ Anchorage, AK 99507-6650 ■ www.muni.org/onsite ■ (907) 343-7904
Well Decommissioning Log
Legal Address: '3.J, $ ve_. -
Subdivision 4, l 1-* Block Lot
T R Section Lot
On -site Water & Wastewater
Program certified contractor performing the well decc
Name: t7 �� Jr�L.I#44 r\ Signature
Company: 5KII (VCR
IWell decommissioning date: W;2-Method of decommissioning: AMC 15:55.0601-1 a. ❑ b. ❑ c.
Location: Use the space below to provide a drawing of the property showing the following items;
• North Arrow
• Decommissioned well,
• Other water wells on the property,
• Two separate swing -tie distances for each well shown in the drawing,
Note: The swing -tie distances shall be measured from either permanent structures of property corners.
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MUNICIPALITY OF ANCHORAGE
,:. tf;
Development Services Department _ -� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 010-185-05 Expiration Date: �( �Q 0
1. GENERAL INFORMATION
Complete legal description AERO ACRES BLOCK 1, LOT 2
Location (site address) 3738 W 43RD AVENUE, ANCHORAGE, AK 99517
Current property owner(s) JULIE M. THWAITS Day phone
Mailing address 3738 W 43RD AVENUE, ANCHORAGE, AK 99517
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
❑
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ /L Z6 Waiver Fee $ //
Date of Payment �7 l 3lo-11/Date of Payment
Receipt Number '?630&0 Receipt Number
COSA # QSG of�6 113 3 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 investigation, based
on procedures outlined in the Certificate of On -Site 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING
Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE
Date 4/2/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
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local soil characteristics, groundwater levels that may fluctuate during the year, quality of
s
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
.Aw •• •• �A �j
��`
•• • ••� �j%
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
01 Q�
*; • 9 L •:* f
for current or future occupants or that no unseen encroachments, deficiencies or
,
/ • • . •
guarantee
discrepancies be by First Water Consulting &
exist can given FWCS
/� •• •Curtis
j
6. DSD SIGNATURE
Huffman •:
�� �F•• CE 128991
f
J System #1 Approved for 3 bedrooms
1�`%q•.4/2/2020•.•��U��
F
F0 PROFESS40
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: /A
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
•
Legal Description: AERO ACRES BLOCK 1 LOT 2 Parcel ID: 010-185-05
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system
A. WELL DATA
D Well log is filed with Onsite (or attached) Water storage tank volume NA gallons
Date drilled CIRCA 1961 Well disinfected for coliform test? ❑ Yes ® No
Total depth *98 ft ® Coliform bacteria is Negative
Cased to *40+ ft Nitrate mg/L ® Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic 33.1 ug/L ❑ Arsenic less than MRL (ND)
® Wires are properly protected
Casing height (above ground) **12+ in. Collected by WN
Date of flow test for COSA 3/30/2020
Static water level at beginning of test 58 ft. Date of Sample 3/30/2020
Well production at time of test 4+ gpm
Comments *Per MOA record docs. **Well in craw space with grade sloping away 1'+ into SW soils.
B--1TANK DATA - NA
Age ofi tanks) _years
Tank type/ma?rial
Measured operating -fluid level in septic tank
® Standpipes/foundation>^leanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA - NAS
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade _ft (max)
Measured depth to pipe invert from grade —f ( if),.
❑ N/A – pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective '
❑ Code -required soil cover,wer field
❑ System presoaked,y
(Required if vacant -for greater than 30 days prior to
date of test)'
Gallons,Atroduced gallons
Comments/Deficiencies:
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:'
Ade4uacy test date
Results ❑ Pass For bedrooms
Fluid depth prior to test in
W i madded gal
New dept ,min
Elapsed time ``min
Final fluid depth in.,
Absorption rate gpd
Any rejuvenation treatment (past'11,2 months)
If yes, enter date ,�
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
*Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
NA ft
❑ Yes if No *50+ ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
NA ft
Holding Tank > 100' ® Yes if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes if No ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑Yes
if No *50+ ft
® Yes if No ft
Frorrq,RSeptic/Holding Tank on Lot to: (Please
enter distances
if less than required) r
Building Fo`bndations > 10' ® Yes
if No
ft
Surface Water > 100' ® Yeses fr of ft
Property Line > 5' ® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5' ® Yes
if No
ft
Private Wells > 100' f✓'` ® Yes if No ft
Water Main > 10' �®Ye-l.,'if
No
ft
Community 1 df'ls > 200' ® Yes if No ft
Water Service Line > 10' ® Yes
if No-, ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please
enter
distances i ,less than required)
BuildingFoundation > 10'
_ ®Yes
if Np�'"�
ft
If a�sorption field is under driveway comment below
Property Line > 10' ® Ya "
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'. ° ® Yes
if No
ft
Private Wells >,I-")'0' ® Yes if No ft
_
Water Service Line ->"10' ® Yes
if No
ft
Community Wells > 200''-'
00''- Yes if No
Surfacepv�1 ter > 100' ® Yes
if No
ft
`
F. ENGINEER'S COMMENTS
*50'+ per regulations at drilling - circa 1961.
G. ENGINEER'S CERTIFICATION
1 certify that l 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.
••••.AW
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AW
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Curtis Huffman /d
CE 128991 .• �w
D AJ2/20;0 •�FAW
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC201133
Subdivision: Aero Acres, Block: 1, Lot: 2
907-343-7904
Fax: 343-7997
A water sample revealed an arsenic concentration of 33.1 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Information on arsenic is available from the On -Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P O Box 196650 `* Anchorage, Alaska 99519 6650 *www mum org
Municipality of Anchorage
Development Services Department
r �\ p Building Safety Division
v Onsite Water 8 Wastewater Program "
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.hlo-1%6-oc7 HAA# CLC
U CrD
1. GENERAL INFORMATION Expiration Date: 2 — 0 6
Complete legal description AERO ACRES SUBDIVISION -.LOT 2 BLOCK 1
Location (site address or directions) 3738 WEST 43RD + ANCHORAGE AK 99517
Current Property owner(s) RONALD DILL Day phone c/o AGENT
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
C/o JERRY LASEVERS w/ REMAX PROPERTIES
Day phone
JERRY LASEVERS w/ REMAX PROPERTIES Dayphone
110 WEST 38TH AVENUE • ANCHORAGE. AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
242-4546
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
0
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 axed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Health Authority 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. 1 further verify that based on the
Information obtained from the Municipality of Anchorage files and from my investigation and Municipalthe
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable
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.
Engineers 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 6 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 soits 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
there 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 owner listed 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 '3 bedrooms.
Disapproved.
Phone 337-6179
Date _!b Loy—
Conditional
y
Conditional approval for bedrooms, with the following stipulations:
�1ts N90
�tiYlQ irilF A
`Q • ON-SITE
� .+ro titin
WASTEWATER
Attachments: p
HAA Checklist L� Maintenance Agreements
Septic System Advisory Supplemental Engineers Report
Well Flow Advisory Other
By: Original Certificate Date:
(Rm. 12!01) .
Municipality of Anchorage
-.
' Development Services Department
eu0dkrp Safety olwwn
O"Its Water 6 Wastewater Program
4700 South Bragaw St.
P.O. Box 196850 Anchorage, AK 99579-8650
wwwxi anchorage.ak.ua
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: AERO ACRES SUBDIVISION: LOT 2. BLOCK 1 Parcel ID: C) to gs = S
A. WELL DATA 41EST DATA FROM WATKINS ENGINEERING.
Well type PRIME If A, B, or C provide PWSID# N/A
Date completed 1961 Sanitary seal (YM) YES
Total depth x98 ft. Cased to x40+ ft.
FROM WELL LOG
Well Log (YM) NO
Wires properly protected (YM) YES
Casing height (above ground) 12+ in.
AT INSPECTION
Data of test 0 x7/29/2004
Static water level ��V- ftx58 ft.
0
Well production N g.p,m. x4.6 g.p.m.
WATER SAMPLE RESULTS:
COiiform _ colonies/100 ml. Nitrate Q JQ mgJL. Other bacteria _�coloniesl100 ml.
-H 9 err
Arsenic: N/A mgJL. Date of sample: Collected by: GEG. LtD.
10 _94-06
S. SEPTICIHOLDING TANK DATA
Tank Type/Material
Tank size gal.
Foundation cleanout (YM)
C. ABSORPTION FIELD DATA
Number of Compartments _
Pumper
Date installed
(YM) _ High water alarm (YIN)
Date Installed Soil rating (g.p.dAix ft1bdrm) _ System type
Length ft. Width ft. Gravel be a ft.
Total depth ft. Eft. absorption area_ ft' Mondorin Depression over field
Date of adequacy test Resul /Fail) For bedrooms
Fluid depth in absorption field be _ In. Water added _gal. New depth _in.
Elapsed Time: n. Final fluid depth _ in. Absorption rate >_
g.p.d.
treatment (past 12 mo.) (Y/N & type)
If yes, give date
D. UFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tasted Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/ltfi station on lot N/A
Absorption field on lot N/A
Public sewer main 50'+
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 50'+
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line Absorption field _
Water main
Water
water
vrow..•
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water service line Surface wat rtveway. parking/vehicle storage
Cu Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION NQS
f certify that I have determined through Reld inspections and r
review of Municipal records that the above systems are in
conformance with MOA HAA guidel/nes in effect on this date. ...... _ • • . • .. • • • ........
ey . ess.
Engineer's Printed Name JEFFREY A GARNESS ' CE-79S� t
Data Pr fag
HAA Fee $ Ly
Date of Payment \\-1Ll-US
Receipt Number —7 5� -
(Rev. ivol) ,'l'
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 010-185-05
HAA #
I. GENERAL INFORMATION Expiration Date:
Complete legal description Aero Acres, Rik 1, Lot 2
Location (site address or directions) 3738 W. 43rd Ave., Anchorage, AK 99517
Current Property owner(s) Avis J Terhune estate
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Day phone
Brian Roit / Dynamic Properties
Day phone 261-7652
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
411.1 fAW
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
El Inoividuai On-site ❑
Individual Water Storage El Individual Holding tank
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer 0
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
valid If r 90 daysDSD fromalso Issues the date of ssue for properties served by a private on request to homeowners. ertificates or Class Cf well and may be reissued Approval
are
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.
own
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validatio date
al sh 'nes fc�this app cationw, I verify that mshows 1hatlthe
based on procedures outlined in the Health Authority App
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 fromand/or
Municipality of Anchorage files and from my Investigation and applicable Mulnicipaleand State codeson-site water supply
o d nances,
wastewater disposal system is(are) in compliance with all app'
and regulations in effect at the time of Installation.
Name of Firm Watkins Engineering, Inc.
Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443 Date 16 _k2'
Cindy W. Ellis b
Engineers Printed Name
• I1
; Cindy W. Ellis
5. DSD SIGNATURE �a'• CE•tosn '
Approved for bedrooms. �` •..�tl- ,O.t•
Disapproved.
ss c
Conditional approval for bedrooms, with the following stipu
Attachments: Maintenance Agreements
HAA Checklist X
Supplemental Engineers Report
Septic System Advisory
Well Flow Advisory Other
Original Certificate Date:
By:
(Rw. O1002)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
50
P.O. Box 1966Anchorage, AK 99519_6650
www.muni.org/onsits
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Aero Acres, ark 1, Lot 2 Parcel 10: 010 18__ 5 p5
A. WELL DATA
Well type Prri
Date completed 1961
Total depth 98 ft.
Date of test
Static water level
If A. B, or C Provide PWSID # _ Well Log (YM) N
Sanitary seal (Y/N) Y Wires properly Protected (Y/N) Y
Cased to40* ft. Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
NA
NA ft.
Well Production NA 9 -P.M.
WATER SAMPLE RESULTS:
q-Zq-o4 W v 7-30-04
Coliform o cotoniesf100 ml. Nitrate <0.1
mg1
Arsenic: NA mg.A. Date of samplegr= G4
B. SEPTICIHOLDING TANK DATA
Tank /Material PUBLIC SEWER -AWWU
Tank sizegal. mhB of Compartments
Foundation cteanout(Y/N) _ Depression overtank
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date install Soil rating (g.p.d./ftz or ft2/bdrm) _
Length ft. idth _
Total depth _ ft. Eft. absorption area
Date of adequacy test
Results (Pass/Fail)
7/29/04
4.6
g.p.m.
9 -Z9 -o4
Other bacteria 4 colonies/1Do ml.
Collected by: C. Ellis / Justin Smieth Wdd+
Date Installed
Cleanouts (Y/N)
water alarm (Y/N)
System type
ft. Gravel below pipe ft.
'19 tube __ Depression over field
Fluid depth in absorption field before test _ In. Water added_ gal.
Elapsed Time: —min. Final fluid depth _ In.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _
For _ bedrooms
In.
Absorption rate >= 9 p.d.
If yes, give date
D. LIFT STATION
Date installed NA Size In gallons
"Pump on level at _in.
Datum Cycles tested
E. SEPARATION DISTANCES
Manhole/Atxess (YIN)
High water alarm level at In.
Meets alarm li circuit require
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlR station on lot NA On adjacent lob NA
Absorption field on lot NA On adjacent lots NA
Public sewer main 80* Public sewer manhole/cleanout t00*
Sewer /septic service fine �d� (41. Holding tank NA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building fou property line _ Absorption field
Water main
Water service line ce water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
PropeNA Building foundation Water main
Water Service line Surface we Driveway, parkingivehide storage
Curtain drain Wells on adjacent bb
F. COMMENTS
Weil is in the crawlspace and was upgraded to code by Anchorage Well & Pu c
G. ENGINEER'S CERTIFICATION h'
49 T ""
1 certify that I have determined9
through field inspections and: '
review of Municipal records that the above systems are In
conformance with MOA HAA guidelines M efled on this date. Ci dy W. Ellis
Engineer's Printed Name Cindy W. Ellis CE tos>r
04.X.'<
Date October 6, 2004 ads'
G� Waiver Fee $
HAA Fee $
Date of Payment Date of Payment
Receipt Number- Receipt Number
(Rev. 1 V01)
AVENUE
N 89059120RE 90.00'
INFORMATION HEREON M FOR THE USE OF LENDNO INSTIMIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
Ex STING STRUCTURES AND PUTTEO LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITKkNIHO ADDITIONAL
HTRMTURES OR FENCELINES
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PUT. ARE NOT SHIOUM HEREON (UNLESS INDICATED,
NOTE ANY FENCEUNES SHOWN ME LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES
ANY PAYING $M WY BE APPROXIMATE DUE TO SNOW CONDITIONS
0
0
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A.
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❑ pow' 49TH *)
o....:...........................
Z O................. rff�+?.:..i
OO � SHANE A. HOLT:
O!, LS -691 4 p,C
04n............^O�oo
AS BUILT SURVEY 1 NO CORNERS SET THIS DATE
SCALE'. 1'-201
1 HEREBY CERTIFY THAT I HAVE PERFORMED A
MORTGAGEE'S INSPECTlON OF THE FOLLOWING
MSCRISEDPROPERTY.
LOT 2- BLOCK 1, AERO ACRES SUB
THE ANCHORAGE RECORpNG TSTRMT,ALASKAANOTHAT
WTHINT E 9JPROVEMENES AS
THEREON ARE
WITHIN THE PROPERTY LINES M AS NOTED HO VISIBLE
EHORGACIENENT9 EXIST EXCEPT A9 NOTED.
GATED AT ANCHORAGE. ALASKA THIS 29TH_
GAY OF JULY_2Bp
HOLT LAND SURVEYING 9l2/.FSII1 ,GPSI
TEL SA}5513