HomeMy WebLinkAboutCHARLICE TR A-3-AOnsite File
Charlice
Tract A-3-A
PID# 067-011-13
Formerly Tract A-3
Municipality of Anchorage . ,797-1
• ��� Development Services Department is
•
- ;' Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 Page
www.ci.anchorage.ak,us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW0203311 PID Number: 067.011.03
of
Jim Lee
Wastewater System: ❑ New
0Upgrade
Address:
26643 White Spruce Dr.. Eagle River. AK 99577
ABSORPTION FIELD
Phone: Number o1 Bedrooms:
6944443 2
O Deep Trench ® Shallow Trench 0 Bed 0 Mound 0 Other.
LEGAL DESCRIPTION
SoilRating:
0.8 GPD/Ft=
Total Depth from original grade:
5.0 Ft.
Block: Lot Subdivision:
Tract A-3 CHARLICE
Depth to pipe bottom from original grade:
2.98 Ft.
Gravel depth beneath pipe:
2.02 Ft.
Township: Range: Section:
F41 added above original grade:
3.34 - 4.44 +l• Ft.
Gravel Length:
53 Ft.
Well: ►Ii
New ■
Upgrad
Gravel width:
5 Ft.
Number of lines :
1
Distance between lines:
NA FL
Classification (Phvate, A. B, C):
Total Depth:
Ft.
Cased to:
FL
Total absorption area:
375 Ft=
Pipe Material:
D3034 & F810
Drier.
'
Date Drilled:
Static Water Levet:
. FL
Installer.
Jim Lee (Owner)
Date Installed:
1017102
Yield:
GPM
Pump Set at
Ft.
Casing Height Above Ground:
FL
TANK
SEPARATION DISTANCES
C. Septic 0 Holding • S.T.E.P. 0 Other:
To
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Pub)ic/Private
Sewer Line
Manufacwrer
Premier Plastics
Capacity:
1000 Gal.
Wel
100'+
100'+
NA
NA
25•+
Matenal:
H.D.P.E.
Number of Compartments:
2
Surface Water
1004
100'+
NA
NA
LIFT STATION
Lot Line
5'+
10'+
NA
NA
5¢e:
Gal.
Manufacturer
Foundation
5'+
10'+
NA
NA
Pump on' level at
'Pump off ac
h.
High water alarm at
In.
Curtain Drain
NA
*50'+
NA
NA
Pump Make 6 • .:
Electrical Inspections performed by:
Remarks:
*noneknown
BENCH MARK
ExistingLocTank & Field Abandoned. New Tank & Field insulated.
arand Description:
Garage slab
Assumed 'titivation.
100 Ft.
Engineer's Stamp
,�.-P•�•�.'A `A'ri+
0*I 4 L . • �j
a.• .. •..•.•....... .... ••
•
:.'Kenneth • uu{(u t
4 J' % CE 7116
". •. .Tear �v ''
e a
e'9LC e••... ....... **,,,q,-
11 0\` �� =`per+
Inspections performed by: KND Engineering, Inc. Dates: 1st 10/6/02
2nd 10/7/02
Developmen Services Department Approval -5' ►lrs/o3�4
Reviewed and approved by: r'/1 Date: --4711074
(Rev. 17!00)
i
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW020311
CHARLICE SUBD, TRACT A-3 PID# 067-011-03
A -C=101.0'
B -C=104.2
A -D=104.4
B -D=107.4
A -E=115.8
B -E=116.6
A -F=167.2
B -F=168.4
04..•> W
11 111
FINAL GRADE
•
..1000 GAL ,_j =n
11 SEPTIC :'1:
11 TANK =III
•=It—tI—It—Il—II=1
OF'44.1,5
:'..:19111
49
t 1 W'Y. D,
`►'• CE -7118'. ..4'•
vo
,r
E-7118
opE
or
4'
sstots�' .�►
114.1116011100:411.-
53.0'
1
1
•
1111
' I_I
' � •sem i 11 L7!
I_I
-1
PREPARED FOR:
JIM LEE
26643 WHITE SPRUCE DR.
EAGLE RIVER, AK. 99577
(907) 694-4443
SCALE' NTS
89.SQ� >a
FIELD BOOKS
80110/" SEWARD
DRAWN:
VBG
STAKING:
STAKING
C IEDKED: KMD
ASBULT. ASBUILT
DA/E/ 01/20/03
DWG FILE
GRD: SW364
AOA) FILE: 01044.DWG
'10B Nat 01044
IND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
�.�1Lw�,
of AL. 1�
�D ENGINEERING , r4 • L •�0
20441 PTARMIGAN BLVD. �. • .•••••••• •••• • 0
EAGLE RIVER, AK 99577-8736 % *i '.tom__ • .;.�
it1 ,t, : Kennet u �+
�, J,'4 CE 7116 •: %
Date Performed: 10/06/02
Performed for: Tim Lee
Project:
Depth
(Feet)
1-
2-
3-
4-
5-
6-
7 -
SOILS PERCOLATION TEST
Charlice S/D, Tract A3 (6959 Clemons Cir.) TEST HOLE # 2002-1
ORG
SM/GM
Bottom of trench
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19 -
HOLE PRESOAKED
20- PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? NA
Date? NA
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
10/6/02
1:00
-
6”
-
2
1:10
10 min
37/16"
29/16"
3
*
1:11
-
6"
-
4
1:21
10 min
37/16"
29/16"
5
*
1:22
-
6"
-
6
1:32
10 min
39/16"
27/16"
7
*
1:33
-
6"
-
8
143
10 min
312/16"
24/16"
9
*
1:44
-
6"
-
10
1:54
10 min
313/16"
23/16"
11
*
1:55
-
6"
-
12
2:05
10 min
313/16"
23/16"
*
Water
Added
Percolation Rate 4.57 (min/in) Perc Hole Diameter 6"
Test Run Between 5 feet and 6 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW020311
Legal Description: CHARLICE TR A-3
Design Engineer: 0070 KND Engineering
Owner Name: Jim Lee
Owner Address: 26643 White Spruce Dr.
EAGLE RIVER , AK 99577 -
Date Issued: Aug 26, 2002
Expiration Date: Aug 26, 2003
Parcel ID: 067-011-03
Site Address: 006959 CLEMENS CIR
Lot Size: 391169 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
This permit is for the construction of:
❑✓ Disposal Field Ej Septic Tank 0 Holding Tank 0 Privy [] Private Well 0 Water Storage
All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By /,( i— Date:
Issued By:
Date: g e, L
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.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I D 067-011-03 Permit Number SW
Property owner(s) Jim Lee Day phone 694-4443
Mailing address (1) 26643 White Spruce Dr., Eagle River, AK 99577
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub d) Charlice Tract A-3
Legal description (Section, Township & Range)
Lot Size 391,169 Acre lSq Number of Bedrooms 2
THIS APPLICATION IS FOR:
Sewer Only ® Well Only
Sewer and Well 0 Water Storage
Sewer Upgrade 0
THIS PROPERTY CONTAINS:
Hot Tub 0 Jacuzzi
Swimming Pool ❑ Water Softening Unit
Therapy Pool 0
Li
o
o
E
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Woo
Waiver Fees:
Date of Payment: ii3l2ldI- Date of Payment:
Receipt Number: 0 231L,V 1 Receipt Number:
(Rev. 12/00)
IK -ND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
July 22, 2002
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer/well permit — Charlice Subd. Tract A-3
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On 8/9/01 we dug one testhole for the proposed system. The results of this test are
attached. The general slope of this lot is greater than 25%, however there is a bench
which is relatively flat as noted on the attached site plan.
We have designed our system utilizing the existing testhole that was excavated for the
2 -bedroom house, which is existing for this lot. The lot will be served by an individual
well, located in the existing house. We propose to install a grinder pump inside the
house and pressure feed the 1000 gallon tank with one 5' wide shallow trench, and
abandon the old undocumented system. Water was not encountered during the
excavation.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
IK1"J+' Engineering
Kenneth M. Duffus, P.E.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
CHARLICE SUBD, TRACT A-3
NO PUBLIC WELLS VITHIN 200' I6
PROPOSED SYSTEM.
NO PRIVATE VELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC STSIENS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED.
%�4?OFAL,
:nom#
CE -7118
•
A413lEsSIOr'"
DESIGN DETAILS
2 BDRM X 150 GPD = 300 GPD
300 GPD/0.8 GPD PER SO. FT. (3.81 MIN/IN.)= 375 SQ, FT
(375/5'(W)) X 0.7(RF) (2.0' GRAVEL) = 52.5 FT. TRENCH
USE 1 TRENCH - 53' (L) X 5' (W) X 2,0'(D)
Total depth of system Is 5.0' from orlglnal grade.
Total depth of gravel below distribution pipe Is 2.0' .
NOTES'
1. USE 1000 GAL TANK, INSULATE TANK IF <4' OF COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS,
PREPARED F❑R1
JIM LEE
26643 WHITE SPRUCE DR.
EAGLE RIVER, AK. 99577
(907) 694-4443
Scale' 1'= 100'
PAGE 1 OF 2
FIELD BOOKS
COMPUTED:
SEWARD
DRAWN: VBG
STARING:
D"EcKED: KMD
ASHULT.
DATE: 8/19/02
D FU
GRIM SW364
ACAD FILE 01044.DWG
406 " 01044
LE ICD ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-8111/FAX (907)696-8111
WASTEWATER DISPOSAL SYSTEM DETAILS
CHARLICE SUBD, TRACT A-3
cc› OF. ALAS i
PREPARED FOR:
JIM LEE
26643 WHITE SPRUCE DR.
EAGLE RIVER, AK. 99577
(907) 694-4443
FIELD BOOKS
B0" N°A" SEWARD
STAIONOe
ASBUILT:
ova FILE:
AC"D "L 01044.DWG
COUPUTED:
DRAMN: VBG
CHEO"ED: KMD
DATE:
8/19/02
f°o SW364
'pB "4 01044
Scale: 1'= 30'
PAGE 2 OF 2
IN.IlI' ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
KNID ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
Performed for: Jim Lee
Project:
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
SOILS PERCOLATION TEST
Date Performed:
Charlice S/D, Tract A3
w
:�Q� o
*****
• �� Kenneth M. Duff / = 4i%
�4 �,., CE7116 tc '
x.
1.
•
4r�•�'''••....•s•' �y�--
08/09/01
(6959 Clemons Cir.) TEST HOLE # 2001-01
Depth
(Feet)
ORG
top 3' tight/dense
SM/GM gray, moist sand/gravel
w/ silt and cobbles to 1'
firm density -
BOH
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO
Depth to water after monitoring? NA
What depth? NA
Date? 08/17/01
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
8/17/01
1:00
-
7"
-
2
1:10
10 min
314/16"
32/16"
3
*
1:11
-
7"
-
4
1:21
10 min
315/16"
31/16"
5
*
1:22
-
7"
-
6
1:32
10 min
42/16"
214/16"
7
*
F33
-
7"
-
8
1:43
10 min
45/16"
211/16"
9
*
1:44
-
7"
-
10
1:54
10 min
45/16"
211/16"
11
*
F55
-
7"
-
12
2:05
10 min
46/16"
210/16"
*
Water
Added
Percolation Rate 3.81 (min/in) Perc Hole Diameter 6" _
Test Run Between 6 feet and Z feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
September 25, 2002
On -Site Water and Wastewater Program Staff:
Re: onsite system Charlice Subdivision Tract A3
I am advising you that 1, as the homeowner, will be installing the waste water
system on Charlice Subdivision Tract A3 (6959 Clemens Circle, Eagle River). I
have the expertise to operate the equipment to accomplish this and will be
assisted by my neighbor John Voehl.
Copies of the design and permit provided to me by KND Engineering are on file
in your office. KND will oversee the installation and do the required inspections.
Sincerely,
Iv Le¢
Jim W. Lee j
�,�y $4,,e 'De..v5 Leib,
Q.S. ..rvJ 11 1
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.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
HAA # DIA 03?b
Parcel I.D. 067-011-13
1. GENERAL INFORMATION
Complete legal description Charlice Tract A -3-A
Expiration Date: / 0 — a. 3 - 0 Li
Location (site address or directions)
Current Property owner(s) Jim Lee Day phone 694-4443
Mailing address 26643 White Spruce Dr. Eagle River. AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
® Individual On-site
❑ Individual Holding tank ❑
❑ Community On-site ❑
❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water 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 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
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 KND ENGINEERING, Inc.
Address 20441 Ptarmigan Blvd., Eagle River, AK 99577
Engineer's Printed Name Kenneth M. Duffus
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. 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, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5.. DSD SIGNATURE
Phone (907) 696-6111
Date 6/29/2004
Is' Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
\`Q\NI,/ OF�4Cy
V •• Ori
a*: • ON-SITE •• ��Gi
, WATER AND t re(:
: WASTEWATER :
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
PROGRAM
O,
Original Certificate Date: 7 - 3 - O 174
-..7Asi.•4/.......4=44.•.4 —
,...,-,
/ •
ztt
Wattl‘sfeakr,fr r‘-') .,:miat=c1„tkiaikstost',,,
Mmiicijrnlity of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater, Program
4700 South Bragaw St.
66r60 eA:6hardge, AK 99519-6650
?lierCiineicerage.ik.us
•907) 343-7904
UTHICAWAPPROVAL CHECKLIST
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ateria
jr,j4e), cAsetlecti-ri•Xsts 0444
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ompartmen s 2 leinou s
, .,..eorio4904yagiimax.•;i:;;t:y" ' ',,,,estansastsfizetigAitkzok4:242::
eahout ) • epression over
...,r,104.,,..zfe‘owi ign water alarm (uNs)N
traPumperagio.; ,.!::”2::: ::,,i..;.siititatiositifistoweagtd2:*g
-ift '‘f;.siiianctotglinventrazzinuntow;
aton c
-4a"Tan size
Selfattni
-'""S•Afelea00,•
Da e insta ed '17
ikr*,
Leng
Soil rating (g.p.d./ft2 or ft2/bdrm) J SS/Sterti, type TII,ENCkl,,,
5 1?-0;.l'Ar Vicalte01,.:`:,•*:.„/„::`atanktia*-1:$2k11016.Z6:4SWIRAt
ft. h 'ft: "Grave selovik pfpe 12)22 ft;
;4* ItkieT,.;r5
a sorption area ft
0,illainti,er Itrists,gasetitgrniN,404,Sifti:k40b.Aiiz::?;„„iit„
11:414e4 C4'.4:S4 gikl./4„
• •
Monitoring kite Y -beg'ression over fieldA5,,,,
Results ail) e for bedrciOrris
'41ANItegediti.Q.?ii‘,"&';&1.101-:,..
a er ad ed ga f,vv ep in.
in
trssrs,art
a sorption •e ore es
&rite ime: min. 'Final fluic
Ir:tesser etra
eYAnsirejuVenatenfrealment (pasf 12 mo.)
greq~n4,'.4„'
,s,44.441y
IsaiHws70114.snlikA4C1a11 i'e41
& type)
yes, give date
D LIFT STATION'
atelrisfalled
"Pump on" level at
Datum. ....... ..,
E. SEPARATION DISTANCES
SEPARATION "bISTANcai
Septic tank/lift station on lot 100'+
Absorption field on lot >100'+
Size in gallons • Manhole/Access (Y/N)
Pump off' level at in.High water alarm level at in
Cycles tested Meets alarm & circuit requirements?
O OT TOi
Public sewer Math
Sewer /septic service line 25'+
'EPAR ITI'O•N'bleAkotS S ic
Building foundation 5'+ y'r Property line 5'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank 100'+
100'+
OD G A`r 0 LO 0:
t
Absorption field 5'+
Surface water 100'+
ter main 10'+
Is on adjacent lot
SEPARATION DIStANtEFRO
Property line 10'+
Water Service line 10'+
Curtain drain 50'+
Wa Water service line 10'+
Wel s 100'+
FA ABSOl2 T 0DO O
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
O:
ilsil
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS
Se c- pipe— . > t 46
No test was needed since it was built less than 2 years aqo. S%S#ear'. toe,. S t^e-anets44 O � ip 1'
aisa LA0
G. ENGINEER'S CE'RTIFYCATIO7 set
I certify that l have determined through field inspections and ;* • ear4°.97
• a
review of Municipal records that the above systems are in
'conformance with MOA HAA guidelines in effect on this date.
Engineers Printed Name Kenneth M. Duffus
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O..wde •,,.,aun• c..•,
GK'S
t
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44,
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Date 6/29/2004 F
�i `RoFEss\o�:�.
Waiver Fee. _,..
/7130.
_'er
HAA Fee
Date of Payment 7 4'V Date of Payment
Receipt Number Receipt Number
(Rev. 12/01) 05-48/ 7
ASBU1LT
e
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
CiY�9�G/CC f'/GO r#wcr>7-.y- '
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRI CTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
SCALE:
Tie
DATE:
7 /9/y
GRID:
FB:
/9.9
DRAWN:
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0404:0--,.,
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• Dwane Merk Seward�"
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LS -6918 .
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