HomeMy WebLinkAboutHENKINS BLK 3 LT 9H
nkin
8lock 3
Lot 9 & 10
#0§1-292-46
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page / of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number:LLa S Pf d'/ / Z S PID Number: a 51 Z fz L{6
Dwelling: 'Single Family(SF) ❑ Duplex (D) (" Multiple (SF and/or D) Project: ❑ New Upgrade
Name:
1---RE e Q eA(/ /� cJsr- ABSORPTION FIELD ? ST/A/C
L1
I q _ ❑ Deep Trench 111 Shallow Trench 111 Bed I=1 Mound
/ ( 'cS ? /JFz vs Le1,\I , l_.,le ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
p3O ` 9 7 77 3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision _ ' Block Lot Ft. Ft.
� - //��/t//J ,Fill added above original grade Gravel length _
Township Range Section Ft. Ft.
•
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line Ft2 Ft.
Well /QU.e- 0p iGo _ zc-,{, TANK ❑Septi S.T.E.P. ❑Holding ❑Other
Y' Manufacturer� /� Capacity
le Surface Water /O Gj/I+
44('F f4AX- /25(1 Gal.
/U Material Number of compartments
Lot Line {O f (O NA- ,ri LL- 2
Foundation !f (f LIFT STATION
lQ Manufacturer Capacity
Curtain Drain S-0.(7‘... 5c -f- 4///C 1QZ,f � 7?-41 K 2 5 Q
Gal.
Pump on level at Pump off level at High water alarm at
Remarks
1, 4 m Sfef
L/Up in. L/`'/ in. 52 in.
Pump make and model Electrical Inspections performed by
P58 OS( a S /f//F: /?/ c Mme ' SG(
PIPE MATERIAL House to tankTank to
Installer ] �3Q� drainfield (7ss
. 6
Drainfield CO/MT 050$q
Inspector /(f-/ BENCH MARK (Assumed elevation) /dQ ft
Inspectiona1� I r'/L-Z /(r 2nd G� 5 /'/ p Location and description `
dates: OJ / G Z /.
3`d 4m / fl
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp
Conditional Approval: Date k�....* .26 •.4.
6.
f
V' ' o
Ito,t,-.. Steven W. .ng y
Appro f �_� �`p + �4,,•404-0. `°o.,`„;,..
pp , 1 w Date � E �9a�p 0FEs. L
Inspection Report_9-1-12.doc
/
AS-BUILT MEASUREMENTS ,
A B
/ DCO 35.5 35
STI 40.2 39.2
ST2 47 47
/
701.111111VirSEPTIC
Lot 10
oQ o
y '� Well
/ (-21:4 , 40A° N, • ''''. R100,1
WELLS .11 ;A
/ . 3 Bdrm iiii., ...if
/ �' V hyo dried Layer Railr •.
�' \ 4Ties For Berm slope
c
/
�/-7.5j fr: -
P1o kal on Ta \ \N.
/ va ���
0 ?V meq. v
o�Q 5% slope ��
r of�ryh c�
N,No Conflicts Within 200'
o
el Decommissioned Old
DEL'S �A. Septic Tank/Lift Station
Per UPC
NORTHRIM .� k WASTEWATER
ENGINEERING *'`49 ... HENKINS SUBDIVISI❑N
SteveEng.corn -�•r • PLAN RECORD
PO Box 7707?• ' : '. • BLOCK 3 L❑T 9
(of*RA4 Alaska 99377 `.. ut-.r. 0'
907.694.7028 6/20/18 STEP UPGRADE os.
/25/I8 ' sr SE ISc417. _ so . I sign 2 of' 3
a
1
I
DCO Tank Cleanouts
/ , - Final Grade /Elevation @ 98.5'
,_l �- e 1250 Gallon
p:. STEP Tank
4' Insulation
InsulationN /Levation @ 98'- I /Elevation @ 98'
r -.To Absorption Bed
vJ /Elevation @ 97. ini
Lation @ 98'4133r i • 5, 1.25' Schedule 40 PVC Force Main
NORTHRIM A . T '
ENGINEERING =*P ... HENKINS SUBDIVISIDN
STEP TANK RECORD
SteveEng. com :4,4%- ,
PO Box 70724 • BLOCK 3 LOT 9
Log!. River, Alaska 99577 % •
IP
907.694.7028 ' • : /k TANK REPLACEMENT °ote:6/25/18 per'"" E.,: SE 1• . 5 :8 of 3
role:
I SE
Rising Son Electric Services LLC.
36784 Eklutna Lake Rd.
Chugiak, AK 99567
4), -.Y':11'L (907) 622-6777
� ,1
it ",ice!. •1\` . ; n\..‘`
( 1
June 25, 2018
Re: 19639 Del's Lane Eagle River,AK 99577
Two whom it may concern:
The lift station at the above referenced address has been wired in accordance with
NEC and State/Local codes and is wired to the manufactures standards. Please
contact Dakota Keller with Rising Son Electric Services LLC with any questions or
concerns at(907) 622-6777.
Thank you for your business.
Sincerely,
Dakota Keller, Owner
Administrator License Number 2065
Specialty Contractor license Number 38497
(907) 622-6777
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: OSP181125
Work Type: SepticTank Upgrade
Tax Code Number: 05129246000
Site Legal Address: HENKINS BLK 3 LT 9 G:0755
Site Mailing Address: 19639 DEL'S LN, Eagle River
Owner: FREEBORN DUSTIN
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
cnr
1.
D('partment
6/14/2018
6/14/2019
27443
❑ 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
Special Provisions: ** An ingress/egress easement is required to be recorded prior to Inspection Report
approval.
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Received B
Issued By:
y: /! Date: �I- l
Date:
Lz� /I- , J"
3
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Munkipafity of Anchorage L �a
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 o Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Proaram
* * * * VARIANCE/WAIVER REVIEW * x * *
Waiver#: OSV181034 COSA#:
PID#: 051-292-46
Legal Description: Henkins B3 L9
Engineer: North Rim Engineering
Applicant: Dustin Freeborn
Permit#: OSP181125
Your request for a waiver of the required 100 feet horizontal separation from the S.T.E.P. tank to
the surface water has been approved. The approved separation distance is 90.0 feet. See the
engineer's waiver request for design requirements.
This waiver approval applies to the proposed S.T.E.P. tank only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
■ ....................... a . 0 . ................... ■ ......... 0 ................... ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: / `T / Approved by:
Name of Reviewer
.................. ............ ■ ............................. ■ ■ " x KM ...... a .... I
**** VARIAN C EMAIVE R REVIEW ****
UNICIPAL1'TY®F ANCHORAGE
a � _
Community Development Department
Phone: 9077343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 0 51_ Z qz- 4/ 6/" 05C)- g777
Property owner(s) Day phone -7 z 6 —
Mailing address _ / 9!g�.3 c? Q FL AA -NE, 4Ff or 4 RIyc�
Site address S 4-WF—
Legal
-W -
Legal description (Sub'd., Block &Lot) /moi 4S 3 `�
Legal description (Township, Range & Section)
Lot Size Z 3 Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF)
Septic Tank Upgrade (w/wo AD U)
Holding Tank ❑ Renewal 6�--8-�o Duplex (D) ❑
Privy ❑ , tiple Dwellings F1F and/or D)
Private Well ❑ JUN 0 5 2018
Water Storage ❑
ti
THIS APPLICATION INCLUDES A VARIANCE / WA 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 Aner or authorized agent)
Permit/Rush Fees: � a lS Waiver Fees:
Date of Payment: & LI ALN Date"of Payment:
Receipt Number: 6C1024 b Receipt Number:
Permit No. ( 3PI 4111,25 Waiver No.
Permit App_9-1-12.doc
!k Tkllll�i�
E C1IG1 N E E R I NG SteveEng.com
Steve :Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
gmail.com
Date: 6/20/18 plumber of Pages: 2
To: MOA On -Site Services, Deb Wockenfuss
Subject: Henkins Block 3 Lot 9
Septic Tank/Lift Station Failure
Waiver Request
A permit was issued to construct STEP tank 100' from creek, as depicted in drawing. During
construction, shallow bedrock was encountered at the proposed STEP Tank site. The only
alternative is to use the previous site for the STEP tank. This requires a waiver to the creek. Instead
of the required 100' separation, we propose 90' separation. The waiver should be granted due to the
following:
1. A previous waiver was in existence @ 85'. The 90' distance is compatible with past
practice. The new STEP tank is waterproof, with no corrosion.
2. The existing slope has a series of railroad ties placed to maintain slope stability. These
railroad ties also have steps to travel down-slope. Another layer of railroad ties will be
placed to act as a beim, for any effluent in the unlikely event of spillage. These railroad ties
are visible to persons in the house and adjacent deck. If any effluent were present, it would
be noticeable.
3. The overland distance around the railroad ties berm is equivalent to the 100' separation.
4. This new STEP tank greatly improves the previous corroded tank and lift station.
If there is need for additional information or clarification please give me a call.
Thanks -Steve
AT
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s .xM®s
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N
ENGINEERING SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 6/5/18 Number of Pages:
To: MOA On -Site Services
Subject: Henkins Block 3 Lot 9
Septic Tank/Lift Station Failure
Maintenance inspection revealed that new STEP Tank is required. A COSA has been submitted.
The existing trench appears to be working OK. Please issue a permit so the STEP tank can be
installed. The existing trench will remain. Please review as soon as possible.
If there is need for additional information or clarification please give me a call.
Thanks -Steve ,
ENGINEERING SteveEng.com Henkins Block 3 Lot 9
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3 -bedroom home. Most of the neighb
o'riT�oe'�
lots are developed. The current septic tank/lift station requires replacement- the 4ep.Q4 still
functions. These lots are large and are served by the water wells. No adverse impacts are
expected from STEP tank replacement. The easements are depicted on the lot. The slope is
indicated in the area of the septic system.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
0 New 2- compartment, 1250 Gallon STEP tank. Anchorage Tank or Equal.
® Watertight couplings on inlet & outlet.
0 5' minimum between the tank and trench. 10' to property lines.
® 4' of cover or insulation is required for tank; an equivalent of I" insulation for V foot
soil cover. Minimum of 2' soil with insulation. Tank & solid pipe must be set on well
compacted, stable soil.
0 Force main to be 1.25" Schedule 40 PVC or equal.
® 4" diameter cleanouts with airtight caps are required I' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field.
0 All cleanouts must extend to at least ground level.
a In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
® Insulation must be placed over any pipe installed under driveways or parking areas.
0 Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
® Sewer Service Line is minimum 2% slope.
® Septic Tank to be pumped every two years or when required.
0 Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
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DESIGN NOTES:
1. Connect New STEP Tank To Existing Trench,
2. Septic Tank & Solid Pipe to be Placed on Compacted,
Stable Soil, Free from Boulders.
3. Sewer Service Line is Minimum 2% Slope & 3' Cover.
4. Water -Tight Couplings,
5. See Specification Sheet,
6. All Work To Conform to Municipality of Anchorage (AMC)
Requirements & Specifications.
7. Decommission Old Septic Tank/Lift Station Per UPC.
8. If No FCO, Install DC❑'s.
9. Check Condition Of Sewer Service Line- Replace If Necessary.
N OR THR/M
ENGINEERING
Ste veEng. com
PO Box 770724
Eagle River, Alaska 99577
907.694.7028
St.,;; -Eng tom;
STEP TANK PROFILE
TANK REPLACEMENT
1250 Gabon
STEP Tank
-►To Absorption Trench
ule 40 PVC Force Main
HENKINS
BLOCK 3
Date` (S/4/18 IBy: SE
SUBDIVISI❑N
LOT 9
Scale: 1, = S I SHEET:3 of 3
Sr
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE ~ ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
NO. OF BE ~OOMS
........-
)'-'IUPGRADE
IF HOMEMADE:
DISTANCE TO: Wetl
!r PERMIT NO.
DISTANCE TO:
Trench width
inch
inches
lines
DISTANCE TO:
DISTANCE TO:
Building foundatio~
OTHER
Crib depth
Sewer line
Nearest Iot l
NO.
Septic tank Absorption area(s)
REMARKS
DATE LEGAL~
~M~UNICIPALITY OF A. NCHORAGE _
Department f--% Health and Environmenta]~rotection
· .. 825 ~ Street,
· .- .~ Anchorage, AK. ~9501
264-4720
Permit # ~ * * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SIT.~ SEWER PERMIT ~-~2 --"? --'
Location: - F .
Legal ~,~hone Number: ~y.-~_ 7//.
Description: /'h/~ Lot Size: -.
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: ~ Holding Tank:
Maximum Number of Bedrooms: j~ Soil Rating(sq.ft/br)
The Required Size of the Soil ~sorDtion Svstem Is: '
. GRAVEL DEPTH G ~' dgJC~/ WIDTH ./~
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall Pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE = /O~O GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection .and approval by this departmer
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fe~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 31, i 9 8 3 * * *
i certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will~nstall the sv~+em in accord ...... -' ....
(3) I u~rs~and t.hat~;n-site s. ewer~;~;teW~'~a;°r~:;;ire enlar ement if
~r~/~/~2~~!ed to ,nclude more that 3 bedrooms,g .
~ ,/~"~ ~: SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [3 PERCOLATION
TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
2
3
4
5
6-
7-
8.
9-
10-
11
SLOPE SITE PLAN
13-
14-
15-
16.
17
18
19
20
COMMENTS
PERFORMED BY~'~!_'~! ~ ,~j,~R~ .~3.~
72-008 (6/79)
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~J ~K (minutes/inch)
TEST RUN BETWEEN FTI ~ND FT
PERMIT NO.
APPL I CANT
LOCATIOn1
LEGAL
TRACY L STIEHR
9999
LOT 9 BLK 3 HENt(INS SUB
TYPE OF SOIL ABSORPTION SYSTEM IS:
BOX 1260 CHUGIAt(, AK 688-3227
LOT SIZE ~99999 SOUARE FEET
DRAINFIELD
MRXIMUM NUMBER OF BEDRO0~IS = 3 SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= ~ LE~4GTH= 5~ GRR%~EL DEPTH= l
THE 'LENGTH DI~IENSIO~I IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTAMCE BETWEE~I THE SURFACE OF THE
GROUND A~'ID THE BOTTOM OF THE EXCAVATION (IN FEET>.
THE TRENCH ~WIDTH IS 5. C~00 FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GR~VEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
RE~.LI I RED SEPT I C TANK $ I ZE= 10£-10 GRLLO~$
PERMIT APPLICA~T HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATIO~-~ INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
------ T~40 ( 2 > I ~$PECT I 0~45 F~RE REQU I RED
BBCKFILLING OF A~'~Y SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIO~I.
MINI~!UM DISTR~-~CE BETWEEN R WELL AND ANY ON-SITE SEWRGE DISPOSAL SYSTEM IS
lO~-~ FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINI~IUM DISTR~'~CE FROM R PRIVATE WELL TO R PRIVRTE SEWER LINE IS 25 FEET AND
TO R COMMU~.~ITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY APPLY. SPECIFICRTIONS R~'~D CONSTRUCTION DIRGRAM$ ARE
RVRILRBLE TO INSURE PROPER INSTRLLATION.
PERM I T
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MU~'IICIPRLITY OF RNCHORRGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAMD THaT THE ON-SITE SEWER SYSTEM I'IHY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO I~ICLUDE MORE TH~N ~ BEDROOMS.
SIGNED: __.
APPLICA~ TRACY L STIEHR
V4. 0
~¢4 --472~
TF:F-'I,C~ L STIEHR
DEPTH= ~ LENGTH= ~ GRRVEL DEPTH=
"I
..... uROU~ RNO T~ 6~T~ ~ ~ ~CflVRTI~ (IN F~r).
F~UIr_~IC~T ~ ~ RE~5I~ILITY TO I~ORN ~[S ~~r ~/R[~ THE]
------ T~JO (2> INSPECTION~ RR~ REQUIRED
D~SR~;~T WILL ~ 5~BJ~ TO
~,~00 FEET FOR ~ PRI~RTE ~L OR i~O TO ~ FEEt FR~ R P~IC ~L ~OI~':
'"':~ON T~ ~ ~ P~[C ~
OTHER ~E~UI~T5 HR~ ~PLV. ~C[FJ~TJO~ ~ CO~T~r[QN OI~ ~
*.;
£ ~ERr£F'F rHSr .'~
C~I'-I--S I TE
PERHIT N0. ( ._°.2~?'~ >
I. RF'PLICRNT TRAC"r' STIEHR
LOCRTION
LEGFIL ' L~ B.~ HENK'INS
MUr-4 I C I F'RL I T'T' OF Ri",! C-:H'-'F'RGE
DEF'RRTHENT },~ HEALTH RHD ENVI RONMEHTRL/~;OTECT I ON
82q_ ' STREET, RNCHORAGE, H,-L",. o.-__. J1
264-4720
SEI. IER PERI',1 I T
SRI BOX &260 CHUGf~k~ 9956?
6S:E:-3227
LOT SIZE 9'~9999 SQUARE FEET
T~-'PE OF SOIL RBSORPTION SYSTEM IS: DRFIINFIELD
MRXIHUH NLII'I~EF' OF BEDROOMS
SOIL RRTING
THE REC!UIRED SIZE OF THE SOIL RE:SOF:PTION SYSTEM IS:
C, EF'TH= '~ LEI"-~GTH= ~ m3 F: R'-.-' E L
/
D.EPTH= '~
THE LENGTH DIr. IENSIOH IS THE LENGTH (IN FEET> OF THE TREHCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE
GROUND RND THE BOTTOH OF THE E,'<CRVATION (IH FEET>.
THE TF-:EI"-dOH I.,I I D-TH I S 5. IZI~t FEET.
THE GRFIVEL DEPTH IS THE MIftIHUM DEPTH OF 6RFtVEL BETHEEN THE OUTFALL PIPE
AHD THE BOTTOH OF THE E×CAVRTION (IH FEET).
F.:EL%!I_I I F:ED SEPT I C TF-H'-.I I--*. S5. I SE= :.,'L~-E~ E~ 0 GFILLCmI'-.IS
PERbllT RPF'LICRNT HRS THE RESPONSIBILITY TO INFORM THIS ["EPARTMEHT DURIHG THE
INSTALLATIOH IHSPECTIONS OF RHY IdELLS ADJACENT TO THIS PPOPERTY RND THE
NUMBER OF RESIDEHCES THRT THE HELL HILL SERVE.
TI,.IC~ ,:'. 2-- ;, I I'-4SF'ECT I 01'-4S RF:E REQLI I RED-
E:ACKFILLING OF RtlY S¥'STEH HITHOLIT FINAL INSPECTION RND RPPROVAL BY THIS
[:,EPRRTMENT 'HILL BE SUBJECT TO PROSECUTION.
HINIHUM DISTRHCE BETHEEN A HELL AND RNY ON-SITE SEHAGE DISPOSAL SYSTEM IS
:!.£~0 FEET FOR R PRIVATE HELL OR 15(1 TO 2~ FEET FROM R PUBLIC HELL DEPENDING
UF'OH THE TYF'E OF PUBLIC HELL
HINIMUH DI~TRNCE FROM R F'RIVRTE [dELL TO R F'RIVRTE SEIdER LINE IS 25 FEET RND
TO R cor,IMUNITY SEHER LINE IS 75 FEET.
OTHER REOUIREHENTS MR'¢ RPPLY. SPECIFICRTIONS RHD CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER IHSTRLLRTION.
PERM I T E,"-:-' P I F.:E$ D.EI~Er,IBER 2-::2.. '1 _'3~ E:2
I CERTIFY THRT
l: I Ar'I FAHILIRR HITH THE RE¢!UIREr, IENTS FOR ON-SITE SEHERS AND HELLS AS SET
FORTH BY THE HUNICIPALIT¥ OF ANCHORAGE.
2: I HILL INSTRLL THE SYSTEM IH 8CCORDRNCE IdITH THE CODES.
3: I UNDERST8ND THRT THE OH-SITE SEHER SYSTEr'I r,iR'¢ REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REHODELED TO ZHCLLIDE HORE THRN c~ BEDROOMS.
, . . ..........
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION,
825 L. Street, Anchorage, Aleska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
10-
11-
12-
13-
14-
15-
16.
17
18
19
20
COMMENTS
DATE PERFORMED:
WAS GROUND WATER ~/:) ~
ENCOUNTERED? _ ~
IF YES, AT WHAT E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
/
PERCOLATION RATE rmlnutes/inch)
TEST RUN BETWEEN F1 D FT
CERTIFIED
72-O08 (6/79)
O ~ E GEOr""!-.CHNiCAL E~ DEVELt~'JMENT, CO.
Russell (~/atet
6.94-2774
Soils Et Foundations
Performed for: Name:
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Legal Description:_
,Depth (feet)
~OIL LOG
Ma.fling Address: B¢~ /~,~
~ot1 Char~ctertsttc~
5
East EIIi.~
688.2280
Land Development
Tel. No. ~-22~c~
~,~-~-'~ ,~,.:'~, ~. ~9~'~
'~dm~.
16
Ground Water Encountered: Yes No. If If yes, what depth
Proposed Installation: Seepage Pit Drain Field. If
~'.arch 27, 1984
~r. Tracv Stiehr
~,.~ 1, ~o~ 12~0
Chugiak, AK 99567
Subject: Lot 10, Block 3 T!enkins ~/D
Tax Code 051-292-45
Doar Mr. Sttehr,
A recent inspection of your property has ~ho~n that an illegal
se%;aqe disposal area i~ encroaching on a ~tate Certified ClasN C
~ell. You are nou ordere~ to do the follow, lng:
~/3)
Discontinue use of the sy~te~ on Lot 10, ~loek 3, by
March 27, 1984.
Pump the nyste~ and ~ub~it a copy of the receipt to this
Department.
Ry June 1, 1984, you mu~t properly abandon the system.
This include~ disconnection of all linea and filling in
the sy~te~ %~ith san:~. An inspection of thi~ work m%lst be
made by thi~ office. I have relayed thl~ infor~ation to
If you have any que~tionn about this order, please contact me at
264-4720.
Sincerely,
Susan Oswalt
Engineer Tech. III
SIGNED
I~_~_~_lp_~oi:~'lJ. 4S 472 S~o PARTS I AND 3 WITH
DETACH AND FILE FOR FOLLOW-UP
PERMIT NO.
r'lLIt~ I ¢ I F/'~L I T~'' OF
DEPART~IENT ¢ HEALTH AND ENVIRONMENTAL , .OTECTION
825 ~L' STREET, ANCHORAGE, AK. 99501
2~4-472~
ldELL PERt~ I T
( 83~26~ )
APPLICANT
LOCATION
LEGAL
TRACY L.
LOT 10 BLK 3 H~KINS SUB
SAR BOX i~60
LOT SIZE
9999 SQURRE FEET
MINIHUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR A PRIVATE WELL OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TVPE OF PUBLIC WELL.
HINIHUH DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITV SEWER LINE IS 75 FEET,
WELL LOGS ARE REQUIRED AND ~IUST BE RETURNED TO THE DEPRRTHENT WITHIN 30 DRYS
OF THE WELL COMPLETION,
OTHER REQUIREHENTS MA~ APPL~, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
eEmr'lI T EXP I RES DECEI'IBER :~:l.- ' 1982-
I CERTIF~ THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE HUNICIPALIT~ OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED:
APPLICANT TRACY L.
V4. 0
· . " _.MUNICIPALITY OF ANCHORAGaE,.,,
· ' Depar~mentr~ Health and Environment ~rotection
· ' 825 _ Street, Anchorage, 3~K. '~9501
264-4720
~ * * HANDWRITTEN'PERMIT * * *
Phone .Number: ~?~-
~gal. Description~. ~;O ~ 5 ~~
~eof Soil.-~sorp~on.Syst~ Is:
Zrench: --Dra~field: · Seepage Bed: '.Holdin~
M~ N~errof Bedrooms: ~ Soil ~ting(sq.ft/bK)
'The Re~ired Size of the Soil ~sorption .System
Applicant
I2Dcation:
iDEPTH -----.L~N~TH . GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) ~f the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
~he gravel depth is the.minimum depth of gravel~between the outfall pipe and
the.bottom of the excavation(in feet). '
* *. REQUIRED SEPTIC(HOLDING) TANK SIZE F GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departme
will be subject to prosecution.
Minimum distance between .a;well and any on-site ~ewage ~isposal system is 100..fe
fbr a.private.well or 150 to 200 feet-from a public well depending upon the type
cf~ public.well. Minimum distance .'from a.private 'well -to a private sewer line
is' 25'feet"and to a community sewer line is"75 feet. Well .logs are required -
and,must, be-returned to.this department within 30~days Df the~well completion.
Other requirements may:apply. Specifications:and.'construction diagrams are
available to:insure'proper.:installation.
* ~ ':PERMIT EXPIRES DECEMBER 31, 1 9 82 "'* *
.I'cert~fy that:
(1) I am 'familiar :with'.the requ'irements for~on-site ~ewers and wells as
set 'forth.by-the.Municipality~of Anchorage.
(2) .I will-install-the system-in accordance with-codes.
(3) 'I understand that the-on-site~sewer'system may Tequire enlargement if
the residence.is"remodeled .to include'more that 3 bedrooms.
;SigneR:.
Applicant .
.Issued .by :.
~Date:
nchora e
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264.4111
TONY KNOWLES.
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
November 20, 1986
Lou Butera, P.E.
Eagle River Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Subject: Lot 9 Block 3 Henkins Subdivision
Waiver Request WR86-163
Dear Mr. Butera:
Your request for a waiver of the 100 foot separation required
between the absorption bed on the subject property and stream
to the south has been granted. This distance has been waived
to 85 feet for the closest portion of the stream.
This waiver is valid for the existing septic system only.
Upgrades or enlargements of this system will invalidate this
waiver.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
EAGLE RIVER ENGINEERING SERVICES
Lou Buler~ P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone {907) 694-5195
November 17, 1986
Mr. Steve Morris
Municipality of Anchorage
Civil Engineer, On-Site Services
P.O. Box 196650
Anchorage, Alaska 99519
REF: Lot 9, Block 3 Henkins
On behalf of my client, Mrs. Anita Nowak, ! am submitting the
information necessary for your determination of a waiver of separation
distance septic leachfield to surface water, to 85' for the above
referenced lot.
The septic system absorption rate has been tested and found
adequate for a 3 bedroom use. The leachfield was installed in 1983 by
Scott Excavating under the inspection of S & S Engineering with
approval by the Municipality at that time, as per the the inspection
report enclosed. It is assumed that the surface water was overlooked
by the inspecting engineer at that time. The slope distance reduction
puts the septic system at 85' horizontal distance. The soil layer used
for absorption is rated as 85 gravel but is underlain by 4' of soil
rated at 150 sq.ft./B.R, absorption rate or 7 minutes per inch. While
current Municipal Code requires a sand filter under 85 material
overlying a water table, this septic system exceeds this requirement
due to the 4' of 150 type soil which would act as the same type filter.
While the horizontal separation distance of 85' ~s less than required,
the travel distance, vertical separation, and associated time of
travel would be greater in this case. The actual minimum separation
distance applied for is at n point where the creek bends towards the
leachfield for a short distance. If this waiver cannot be approved the
original inspecting engineer should be contacted to determine what
action is necessary.
Sincerely,
Lou Butera, P.E.
RECEIVED
EAGLE RIV~'''h
ENGINEERING SERVICES INC.
P. O. Box 773294
EAGLE RIVER. ALASKA 99577
Phone 694-5195
CHECKED
DATE
;
• Municipality of Anchorage •
On Site Water and Wastewater Program
tet _ (907) 343-7904
.JAMB
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-292-46 Expiration Date:
q—'27—le
1. GENERAL INFORMATION
Complete legal description Henkins Block 3 Lots 9&1O
Location (site address) 19639 Dels Lane, Eagle River, AK
Current Property owner(s) Freeborn Day phone 726-1112
Mailing address same
Real Estate Agent Owner D, pthbrte 6-1112
�v � Se7's11 1.
2. TYPE OF DWELLING: MAY I 8 2918
® Single Family (w/wo ADU) _3
7 Duplex "6 ti
c
n Multiple Dwellings (Single Family and/or Duplex) it of s s L ��
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer
Received by: - , Date: 6 Z d ie
COSA to be released to the engineer, unless otherwise ested by the engineer.
COSA Fee $ 52‘.., Date:
Date of Payment 5121 d Ie _ Date of Payment
Receipt Number c�j(,) Receipt Number
COSA# n6(' 12J(4 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.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724,Eagle River
Engineer's Printed Name Steve Eng Date 5118/2018
01= 4.4 %
W�� ,e0aw40 pA •
be
C L?th
6. DSD SIGNATURE ° *
System #1 Approved for 3 bedrooms.
En ( c_
System #2 Approved for bedrooms. Steven �.. s •w
1' ' 6256 •aa
Disapproved. y f%:�; r(st��: =
a4 �'1Cr t : Fts
Conditional approval for bedrooms, with the following stipulatibn� "'A''" u
j - Y�l
WATR AND
N1ASTEWON ASITETER
`n;
PROGRAM
f),J CG..
h�tc.A,— r.t
By: �---�% - Original Certificate Date: lO
The Municipality of Anchorage Devlopment 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: fir•ca
COSA Checklist X Nitrate Ad�f§ory'�:j;,a
Septic System Advisory Arsenic,$cisori.r
Well Flow Advisory Other
COSA blue sheet 9-1-12.doc - t `"•� y�•`
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of In-Site Systems Approval Checklist
Legal Description: I A/ //I! $ 33 47 Parcel ID: c5t Zcf2 -C
A. WELL DATA
Well type / If A, B, or C provide PWSID# Well Log (Y/N) ti/
Date completed 0.37F-3 Sanitary seal (YIN) y Wires properly protected (Y/N)
Total depth L/Z5ft. Cased to ft. l'`rrd' Casing height(above ground) //Z in.
dPcel`OcIZ
FROM WELL LOG AT INSPECTION
Date of test V/�3f(r3
Static water level 350 ft. ! .( ft.
Well production /6 Z. g.p.m.
WATER SAMPLE RESULTS: >�t t CG�'i7 e o&Q7-e- l�lac.v
Coliform 0 colonies/100 mL Nitrate O.57mg/L
Arsenic O, ?-S ug/L Date of sample: .Sfldne Collected by: irn
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material .'S Tf.,/'//
CS7, Date installed 6720/i 8
Tank size/2 So gal. Number of Compartments Z Cleanouts (Y/N)
65c-0)
Foundation cleanout(Y/N) / Depression over tank (Y/N) Ai High water alarm (Y/N) y
Date of pumping Aig60 Pumper
C. ABSORPTION FIELD DATA
'co.!ed
Date installed /0/e3 Soil rating (g.p.d./ft2 or ft2/bdrm) ?5 System type ,��
Length 35 ft. Width /Z ft. Gravel below pipe O' g ft.
Total depth 3 ft. Eff. absorption area Igo ft2 Monitoring tube y Depression over field ,/
--SIO of adequacy test � Results (Pass/Fail) P / For 3 bedrooms
Fluid depth in absorption field before test a 5 in. Water added 143-6 gal. New depth z in.
Elapsed Time: 3 d min. Final fluid depth O.sn. Absorption rate >= 415 O g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed PS(Z0/( 8 Size in gallons 1,5 a Manhole/Access (YIN)
q /52. in.
"Pump on" level at in. `Pump off' level at y� in. High water alarm level at
Datum ,Bee3141 Cycles tested 3 Meets alarm&circuit requirements? y
E. SEPARATION DISTANCES
WELL ON LOT TO:
i
Septic tank/lift station on lot !00 f On adjacent lots /do 4-
Absorption field on lot /rQ 0 i On adjacent lots /s 'Q 'f
r
Public sewer main 0 Q' c f Public sewer manhole/cleanout / 0 0 'f'
t
Sewer/septic service line 2 -f Holding tank /D O' *
r ( ,
Animal containment areas 5 0 f Manure/animal excrete storage areas /UV ,
SEPTIC/HOLDING TANK ON LOT TO:
1
Building foundation /Q r f Property line /0 f Absorption field "�
Water main / Q f r
Water service line / � Surface water
9 j14-
Wells on adjacent lots /0 a '4-
ABSORPTION
fABSORPTION FIELD ON LOT TO:
i
Property line �� 14 Building foundation /0
r Water main l/ f
Water Service line Al rf Surface water Q t Driveway, parking/vehicle storage
Curtain drain v/(/lt. Wells on adjacent lots / V "/—
F. COMMENTS
74" tAin/v12
*?t FRfV!d0.s w4-/V
G. ENGINEER'S CERTIFICATION "" OF A( %
.®��,....•... .,, 0,1.it
I certify that 1 have determined through field inspections and S�'�� �, d .
review of Municipal records that the above systems are in ryt s' Y� .1, ...19*
. 0�.
conformance with MOA COSA guidelines in effect on this date. f.--
*=`�� J�. .7;' • :;••• 'I
Engineer's Printed Name 0 7:-t— c 4,0
Date X72(//i ØI�.'. . ,,..
fr
ii F E D\�C+�.'
COSA yellow sheet_2-6-15.doc
Ecklund, Timothy J
From: northrimeng@aol.com
Sent: Tuesday, June 26, 2018 7:10 PM
To: Ecklund, Timothy J
Subject: Re: Henkins lot 9
Tim.
Here are my Notes:
93.6' Static measure
Start Well Flow @ 0956 @ 5gpm
Well Level @ 166.2' @ 1056 (1 hour later)
Well Level @ 195.8 @ 1101 (102.2' Drawdown)
Stop Pump- Measure Well Recovery- Measuring by Minute
Well Level @ 194.8' @ 1102
Well Level @ 193.3' @ 1103
This equals 1.5' per minute Well Flow. 1.5' of water column is the equivalent of 2.2 gallons.
Flow = 2.2 gpm, If I had drawn the well further down, the flow rate would have increased.
Steve . rrr2
4v5.?e'sd'Gr, zao 2
N, i)tA
B3 0
.. 1
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of
il-
Qi
A oi, ' &1.\
I • D. 6 U R i
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c• o j-9l��,, �S� / Z�0
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-., , • t•'0�, \' Arr. _vp,R�` •
'a 0 zdo0 .... 4‘
jr r
V .czy8••ro o 8a
.
1L 01 I
IV
•
OS
C) • • .
�a ti • R!
c ki°
\ • .. ,•• .1 Ali ' 4‘ •
[j
.b l
6k.`. \ ti/�
3 •
t 6, 4 `/
•i /1/1 \
. • O�O ' yr \ •
t
I - • Ess k\i, .
6.• t °•• I 6/d/'8����7/� GST/CX/ •
8/2//4' /i" CE� /�/ei9.'7e.:W
,(
• . ‘/7/79 /P///�?-,4
_F49 79� .CfC/�ro /
9/•s/z .117��' c'";ee-�,�s' G90.0829
ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688 4566
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE
FOLLOWING DESCRIBED PROPERTY: Lot 9 & 10, 1" = 30' .� OF 1�t Nq
Block 3, Henkins Subdivision DATE: ,v�� •• .....'•._5�4
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 6/30/92 �� . `c-' •.-
INDICATED. IT IS THE RESPONSIBILITY OF THE i�;' 4 PV
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: 0iii "'•d /
EASEMENTS, COVENANTS, OR RESTRICTIONS NW755 le: ..4..#1,. ef . z.•-g
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- '. Duane Mark Seward t`,p
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' fi•,/.5..-,.. lS-e ` \
ANY DATA HEREON BE USED FOR CONSTRUCTION 30-03 , ,•. ���<' `P,�
OF FENCE LINES, OR FOR ESTABLISHING BOUND— DRAWN ��1%47-0x \-st' r
ARY LINES_ -aa.-w.m..v`'
DMS
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore 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
051-292-46
Parcel I.D.
GENERAL INFORMATION
Complete legal.description
Location (site address)
Current Property owner(s)
Mailing address
COSA# ~"'~_.~ ~_..
Expiration Date:
Henkin$ S/D, Block 3, Lot 9&lO
19639 De[s Lane
Dan Kruse
19639 Dets Lane
Day phone
696-3310
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address
FSBD
Owner
Day phone
696-3310
Unless otherwise requested, COSA will be held by DSD for pickup.
3
NUMBER OF BEDROOMS:
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 On-Site 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 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 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 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.
Name of Firm Nor'thRim Engineering Phone 694-7028
P,D, 3ox 7707P4
Address
Engineer's Printed Name S-t:eve En9 Date 7/9/10
DSD SIGNATURE
Ix//' Approved for "~
Disapproved.
Conditional approval for
.- OF A ~
.,. ~.....,../, t
bedrooms. ~. ~[,,. ,~ ~56 .%-g~
bedrooms, with the to,owing supu~auons:
By:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory ~
Nitrate Advisory
Arsenic Advisory
Maintenance Ag reements
Supplemental Engineer's Report
Other
'~~'~ Original Certificate Date:
(Rev. 11/05)
Municipality of Anchorage.
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Descdption: Henkin$ S/I}, BI, ock 3 Lo-cs 9&lO Parcel ID: 051-;:)9;:>-46
A. WELL DATA
Well type P If A, B, or C provide PWSID # ~
Date completed 4/83/83 Sanitary seal (Y/N) Y
TOtal depth 4;:)5~t. Cased to -~. Tiq-I;o
FROM WELL LOG
Date of test ' 4/83/83
Static water level ::3 5 0 ft.
Well production 10 g.p.m.
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Bed~a°s~height (above ground) 1;:>~ in.
AT INSPECTION
7/8/10
385 ft.
0,9 g.p.m.
WATER SAMPLE RESULTS:
,. Coliform 0 colonies/100 mL Nitrate 0,437 mg/L Other bacteda
'Arsenic:. -0-"~54 ug/L date of sample:. 6/84/10~ Collected by:.
B; SEPTIC/HOLDING TANK DATA
Tank Type/Material G.r'eer (steel~)
Tank..~ize !~QPO gal. Number of.Compartments'
· FoUndation cleanout (Y/N). Y Depression over tank (Y/N) ..... N
· Date of ptjmpjng ~,/5/10 Pumper JR'$
C. ABSORPTION FIELD DATA
Date installed 10/83 Soil rating (g.p.d./ff2 or ff21bdrm)
Length 3 5 ft. Width 18 ft.
Total depth 3 ft. Eft. absorption area 4;:>0ftz Monitoring tube Y
Date of adequacy test 7 / ;:) / 10 Results (Pass/Fail) P (~ $ $ '
Fluid depth in absorption field before test 0 h-
in. Water added 4 5 0gal'
Elapsed Time: ~'0min. Final fluid depth. 0 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (WN & type)
0 'coloniesll00 mL
NRimEn9
If yes, give date
New depth
45O
mound
System type
Gravel below pipe 0,5
Depression over field __
For
N
3 bedrooms
1 in.
g.p.d.
Date installed 10 / 8 3
CleanOuts (Y/N) Y
High water alarm (Y/N) N
LIFT STATION
10/83 500
Date installed Size in gallons
"Pump on' level at. 96 in. "Pump off" level at. 94 in.
Datum Riser- Top Cycles tested 2
Manhole/Access (Y/N) Y
High water alarm level at 95 in.
Y~
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
'Public sewer main nc
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout NA
Sewer/septic service line
Animal containment areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' + Property line~10' + Absorption field
Water main nc Water service line 25' S'brface water
· Wells on adjacent lots 100' +
Holding tank NA
Manure/animal excrete storage areas
5' +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10' +
Water Service line
NA
Curtain drain
Building foundation 10'+ Water main
$5'
Surface water Driveway, parking/vehicle storage.
100' +
Wells on adjacent lots..
10'
COMMENTS
G. ENGINEER'S CERTIFICATION
Engineer's Printed Name
Date
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.
~-I;eve Eng
7/9/10
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
t.(qo
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ti. anchorage, ak. us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems Approval (COSA) # 101115
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 9&10 of Henkins subdivision, the well's
productivity was determined to be 0.9 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3-bedroom
residence is 03 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
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
(9O7) 343-79O4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR: A SINGLE FAMILY DWELLING
Parcel I.D.
1. GENER~E INFORMATIO~I
~mplete legal des~p{ion
Lo~tion (site address)
C~ent Prope~ owne'r(s)
Mailing ~ddres~
Expiration Date:
Day phone _~'~Z-/'o
Lending agency
Dayphone
Mailing address
Real Estate Agent
Dayphone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
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 On-Site 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 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 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 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 ver'~y 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 ~0~-/'~/~',~t ~.
Engineer's Printed Name ~'T"~u"~ t~:~/q'¢
Phone ~('~'?.~- 7~'z°e'
DSD SIGNATURE
/ Approved for -.~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
7-
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Westewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munLorg/onsite
(9O7) 343-79O4
CERTIFICATE OF ON-SITE SYSTEMS APPRO~,~jCHECKLIST
LogalDescription: //'//~--~'~./'(',~/'/(~,~ _~'/~ ,~'Z'C~C~_ ._~ ~O~"~.*/~,arcellD:~)_~A"/-,,~C~2
WELL DATA
Well type P
Date completed ,(//,~.~/~
Total depth/,/',ZE' ft.
Date of test
Static water level
Well production
ff A, B, or C provide FWVSIO #__ Well LOg (Y/N) ~
Sanitary seal (Y/N)_y__~' Wires properly protected (Y/N) "~
Casedto ~' ft. /_~;'~)~eeC-~'-Casingheight(aboveground) .Z'J~ in.
FROM WELL LOG AT INSPECTION
ft. ~dS ft.
WATER SAMPLE RESULTS:
Coliform (~ colonies/100 mL
Arsenic: ~ mO/l
SEPTIC/HOLDING TANK DATA
Nitrate (2, ~'O~/' mg/L
Date of sample: ~'/~'/0~'
- Tank size//~1{~ {~ gal. Number of Compartments ~'
Foundation cleanout (Y/N) ~ Depression over tank (Y/N) ~
, Date of pumpiog ~"/2 2/OC Pumper ~-'/eJ~
C. ABSORPTION FIELD DATA
D;te installed .~_~' Soil rating (gp.d./ft2 or ft2/bdrm) ~'
Leogth ~'_,~' ft. Width //,~- ff.
Other bacteria C~' oolonies/100 mL
Co, :ted by:. ^/o
Date installed //~/~°.-,F
Cteanouts (Y/N) \/
High water alarm (y/N)
System type
Gravel below pipe 0,, -~' fl.
Total depth .3~ ft. Eft. absorption area t.,/20 ft2 Monitoring tube ...~_.
Date of adequacy test ~'/~'~/O~'~ Results (Pass/Fail)
Fluid depth in absorption reid before test (:~ in. Water added~-5'(~gal.
Elapsed Time: .~0'min. Final fluid depth O in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Depression over field
For ...T' bedrooms
New depth O. ~ in.
Absorption rate >= Zl/-R"O'f' g,p.d.
If yes, give date
D. LIFT STATION
Date installed
on' level at ~_ in.
'Pump
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off level at
Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank~ift station on lot
Absorption field on lot ./~ 0 ~ V--
Public sewer main /~'/~.
Sewer/septic service line
Animal containment areas
On adjacent lots
On adjacent lots //~d' '-~-
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~ '~' Property line / 43 w.f
Water main /~/'/,'~ Water service line. ~',~" ~'~
Wells on adjacent lots ~/~:~? ~''~'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t/~/'~'
Absorption field
Surface water
Building foundation ~/(~ '''f' Water main
Water Service line -~--~ ~' Surface water 4~ ~ / ~' D~iveway, parking/vehicle storage
Curtain drain -- Wells on adjacent lots //~ ·
F. COMMENTS ~'O_..,~JZ~-~..~
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 ~'7-~'~'~
Date r/.~Oc
COSA Fee $
Date of Payment
Receipt Number
(R~. 11~)
Waiver Fee $
Date of Payment
Receipt Number
ASBUILT-NO CORNERS SET 'THIS DATE.
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE.
FOLLOWING DESCRIBED PROPERTY, 1'.o1:
Block 3.Henkins Subdivision ·
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRIC. TIONS
WHICH DO NOT APPEAR ON THE [RECORDED SUBDI-
VISION PLAT, UNDER NO DIRCUMSIANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION'
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES,
SE[~ARD &
SCALE,
1" = 30' "
DATE,
6/30/92
GRID,
· t~;755
FD~-
30-03
DRAWN,
?THRIM
I~NEERING
MEMO
Steve Eng, PE, PH
17237 Bear Paw Circle, Eagle River AK 99577
(907) 694-7028 tel
(907) 694-7026 fax
NorthRimEng@aol.com
Date: 6/30/06
Number of Pages: 3
To: Jeff Poet
MOA On-Site Services
Subject: llenkins S/D, Block 3, Lots 9 & 10
Jeff,
On 6/29/06 an investigation was conducted on the subject drain field. Dan Green w/Green
Excavation performed the excavating. We excavated out the end of the field & discovered I foot
of drain rock. The field was completely dry with no odor. The existing monitor tube was
investigated and a lateral line from the pressure pipe was discovered entering it. This most likely
skewed the performance ofthis monitoring tube.
A new monitor tube was installed. Photos included. Another test was performed on the field and
reported in the new COSA checklist. The water well sanitary seal was caulked where the wire
enters the cap. The manhole on the lift station was also screwed down.
Please issue the COSA approval.
Thanks-Steve
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # (3R1 -~q2-4R
HAA# HA990197
GENERAL INFORMATION
'"Complete'legal description
Lots 9 and 10. Block
3, Henkins Subdivision
Location (site address or directions) 15630 Del's Lane
Property owner c,~-t-t ~ ~R~,r Day p~one
Mailing address 15630 Del's Lane Eaqle River, AK
Lending agency Day phone
Mailin. g address.
694-2857
Agent
Address
Day phone
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Three (3)
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL~
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 of this Health Authority Approval application 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 Anderson P. ngineerincj Phone 522-7773
P.O. BOX 240773 Anchorage, AK 99524
Address _.
Engineer's signature
Date
DHHS SIGNATURE
[/'"' A?proved for T H J~E-~bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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 order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct 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.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
051-292-46 HAA# ~.,~L'~C~--~
1. GENERAL INFORMATION
Complete'legal description
Lo~ 9 and 10, Block 3f Henkins Subdivision
Location (site address or directions) 1 5(;:~Q Alder Lane
Property owner Curtis Baker
Mailing address 15630 Alder Lane
Day p~one 694-2857
Eagle River, AK
Lending agency
MEili~g address.
Day phone
Agent
Address
Day phone
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Three (3)
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
. Community on-site
Public seWe~·
NOTE:
XXX
If Community wasteWater system, provide written'confirmation from State ADEC
attesting to the legalit~ and status of system.
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 of this Health Authority Approval application 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 in~licated 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.
Phone 522-7773
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer'; signature 7'~~ ~ ~
Date 5/5/99 ,--
DHHS SIGNATURE
Ap.proved for .7"/-/J~' bedrooms.
Disapproved,
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
.i
The M~Jnicipality of Anchorage Department of ·Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registe red in the State of Alaska. The D H HS does this as a courtesy to p umhasers of homes
an d their lending institutions in order to satisfy certain federal and state req uir~rne~s~ Em ployees of DHHS do not
conduct Inspections or analyze data before a certificate is issued. The Mun, iciPa!ity Of Anchorage .is not
responsible for errom Or omissions In the professional engineer's work. _
Municipality of Anchorage R F
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MAY
825 L Street, Room 502 · Anchorage, Alaska 99501 · (~}c~.
Oept. Health
Legal Description:
A. WELL DATA
Wall tTpe Private
Log present (Y/N) Y
ToteJ deptfl 425 '
Sanitary ~eal (Y/N)
Health Authority Approval Checklist
Lots 9 & 10. Henktns Sub. ParcalI.D.: 051-292-4~
Block 3,
ff A, B, or C, altech ADEC letter. ADEC water system number
Date completed 4/23/83
Cased to 6 ' Bedrock Casing height (above ground)
¥ Wires properly protected (Y/N)
2I
Da~u of test
Statio water level
Well production
WATER SAMPLE RESULTS:.
Coliform 0
FROMWELLLOG ATINSPECTION
4/23/83 75' 4/8/99
75' 75'
.17
Nttmte
Dateofmunple: 4/13/99 and 4/27/99
SEPTIC/HOlDING TANK DATA
g.p.m.
1.26 mg/L
Co#ected by:
1.1 g.p.m.
Other bacter~ 0
T. Ktmbrou~h
Datelnstelled 10/83
Feue~t..ondeanout(y/N)
Date~Pun~ng 1/la!QQ
ABSORPTION REIDDATA
Date lnstalled 10/83
Lenglt135~Width 12'
EffeclNeal~xptlonama420 SE
Dete~tm 3/16/9~
Tank~ze I ,000 Number of Compartments 2 Claanoute(Y/N) Y
Depression (Y/N) N High water Mann (Y/N) N
Systemt~pe Raised Bed
~ ' To~ depth 4.5 '
Dep~on over field (Y/N) N
Sollmang (g.p.dJffforftVbdtm) 85 SF
Gravel tt~ckness below pipe
Monitoring Tube presem (Y/N) Y
Results (Pass/Fall) Pass For Th~*ee bedmoms
Fluiddepmlnabsoq~onfleldbefomtestOn.); 6" ImmedlatelyMter 519gal. wateradded (In.): 10"
Fluk:ldepth 6" Om)Minutes later.. 24 Hours Abeorp~onrate = >450 g.p.d.
Peroxide tmaUnent (past 12 monlhs) (Y/N) N ff yea, give date
D. LIFT STATION
Date installed 10/83
Manhole/Accees (Y/N) ¥
Absoq~fion field on lot
Public sewer main
Sewer/septic sewice line
High water alarm level at* 45"
Cycles tested Five
E. ~PARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot > 1 0 0 '
>100'
N/A
Size in gallons
'Pump on" level at* 43"
'Datum Bottom q£ Tank
On adjacent lots > 100 '
>100'
On adjacent lots
Public sewer manhote/cteanout
Lift station > 100 '
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line ;> .~ ' Abseq0fion field
Water main/serviceline >lQ' Surlacewater/drainage ;>1oo'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line
Surface w~ter
Curtain drain
gna
"Pump off' level at' 43.
N/A
WelLs on adjacent lots
Building foundation , ~ n_, Water maln/senrice line
~ ~t~,~ ~ D~u~way. partdng/vehicle storage ama
None on Lot
Wells on adjacent lots > 1 Q 0 '
>10'
Waiver Fee $
Date of Payment
Receipt Number
04/14/1989 18:24 3453287
· Fax Tran. nittal Memo 7872
M-W Drilling, Inc.
April 07, 1999
15630 Alder Lane
Eagle River, AK 995??
Lot 9, Block 3 Haskins S/D, Chugiak, Alaska
Water Well Rehabilitation, As-Built Notes
1. Well Btatistics: Total Depth: 425'; Casing:
Static ~evel~ ~2'+/-~ Original ¥ield~ 10 OPH
2. 3/29/99: Pump pulled and attempted to ~est the ~ell, not
enough recovery to pump a~tsr 30 minutes.
3. 3/30-31/99: Hydroiracked well with packer settings as below:
Set No. Set Depth Max Pressure
70'. 600 1500
154' 900 1000
238' 500 2000
322' ?00 1000
'4.2
4.3
4.4
Nitrate Ramedtation Measures:
4.1 Run 1/ncr casing consisting o~ 4.5" PVC pipe, vith 2 each
rubber shale-cup packers in bottom 2', ~rom +2' to -58'
~rom ground level(i.e., top ~ -3" ~rom top of casing).
Grout 4.5" x 6" annulus with 60 gallons of cement, (8
gallons per sack), grout mix.
Post Treatment Yield: I GPM, Nitrates = 6.5 M~/L
4/1/99 Pump reinstalled on 19 Joints, -403' to intake,
plumbed out the top (i.e., no pitlsss adapter).
Zf may ~uestions remain iR this regard, please cent&et our o~lce.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lo: 9~ 8t. oci: $~ ~n~J. n6 $~zbc~uZ6,~on;
Location (site address or directions) 15650 AZde~ Lart¢
Property owner
Mailing address
Lending agency
Mailing address
Age ntl)cut,t, en~
T~acy
P. 0. Box 770909
Day phone
Ectq,~e I~v~tt A,bz6/z~ 99577
696-5733
Day phone
RE/~AJ( 0F EAGLE RIFER Day phone 694-4500
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Address 16600 C~,~d ~),'z,/,ue Ea,q~¢ R~ue,.tt~/z~. 99577
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide wdtten confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 of this Health Authority Approval application 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
Address
Engineer's signature
$ & $ ENGINEERING
Eagle River, Alaska 99577
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Phone__
Date
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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 order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct 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.
During a recent Health Authority Approval on-s~e inspection and
test, Qf .the pgtable water supply well on Lot ~ Block _.~_9 _
of ~-/~/~;/~' Subdivision, the well's productivity
was determined to be~,~7 gallons per minute. The minimum well
productivity required by this .d~partment (AMC 15.55) for
a ~ bedroom residence is~'.~/ gallons per minute.
Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and watering lawns
and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
.Legal Description: ~'~' °l ~-~"/'-'"~ ~'~;~--~V'~,6/-~· Parcel I.D.
A. WELL DATA
Well type '~{Z4 V/X~'_.-
Log present,iD'N)
Total depth ~2-~' ~
Sanitary seal ~'N)
IfA, B, or C, attach ADEC letter.
Date completed
Cased to
ADEC water system number t~'~-
~t..~_~..~, Driller ;;~"~'~ ~uJ,[.c,/~/.-/.,.'
'~P~'~ ~//-'- Casing height 12. ~" ~'-
Wires properly protected (~N) y
Date of test
Static water level
Well flow J ~' ~'"~" ~
Pump level U 14-
FROM WELL LOG AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I, C>c>~ ~
Absorption field on lot \D,-~\ ~'
Public sewer main ~[A-
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~ '~.o~11/~,~,..~ Nitrate
Petroleum tank
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Other bacteria
S& S ENGINEERING
17034 Eagle River L~op
Eagle River, Alaska 99577
Tank size ~ Cx~&:> ~ Compartments
Cleanouts~/N)
High water alarm (Y/N)
Date of pumping ,~-' ~'~-~--" Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~o t On adjacent lots ~,~,~
To property line ~ ~ t-~-- 'Absorption field ~'" ~
Surface water/drainage /~o ~ '
Foundation cleanout ~TN) ~ Depression (Y/~I~
~J~-' Alarm tested (Y/N)
Foundation ~1 I
Water main/service line /E) I '~'''
72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE
C. LIFT STATION - "
Date Installed ~O o ~>~ Manufacturer * ~
Vent g/N) '~ "Pump on" level at 7.. / ,,OF-~ ,C~'~ "Pump off" levei at
High water alarm level
Meets MOA electrical codes ~N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot I, o c, ~' On adjacent lots
D. ABSORPTION FIELD DATA
Date Installed t c> ~
Cycles tested
Surface Wa~' ! ~ c, t
Soil rating ~' ~'/~'~' System type
Length' "~
Total al~sorpti0n'area
Depression o~er field
Results ~.s~fail)
Gravel thickness
~ Cleanouts presenhi~/N) ~
Date.of ade, quac¥ test
(*)
Total depth
bedrooms
..Peroxide :eatment (past12 months) (Y~J~ ..~.'~' t~°~J If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot ~o~~
To building foundation
On adjacent 10ts ~1~
Sudace water IG~ ~ Drive~ay, pa~rking/vehicle storage area
Cu~aindrain ' ~ ~ ' ' ' '
E, ENGINEER'S CERTIFICATION ' ~
I ce~ify that I have checked, verified, or conformed to all MOA and H~ guidelines in effect on the date of this Inspection.
On adjacent lots ~,c,~ t.)c- Property line
~ ~ To existing or abandoned system on lot
Cutbank ~' Water main/service line
Signature . , ~..~ ~,. ,~n~
Eagle R vet, Alaska 99577
Engineers Name ~
HAAFee$ /70 O0
Waiver Fee: $
Date of Payment ~- ],~ ~ ~ ~) Date of Payment
Receipt Number ~ ~ ~-- /~ Receipt Number
ROBERTSHAFER, P.E.
ROGERSHAFER, P.E.
1992
CIVIL ENGINEERS
(907) 694.2979
FAX 694.1211
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
SITE PLANS
ROAD DESIGN
SOIL TEST
T~t~cg StZe/~.
P. O. Box 770909
Eag,~e I~ue.,r, A.~6h. zt 99577
REFERENCE: Lot 9; B~ock 3; He,rd'c~.~,~, S~bd, ZuZ6Zon;
,'[e{erenced prope.,ctV on M~zV 12, 1992.
w~ ~Zng. A ~ ~ conne~ be{o~e ~ hoL~n~ ~ and
~ ~e ~p ~02 {t.). The ~p ~ ~ ~ o~ aMthe~
the ~p ~ ~n~ on a~n aM ~he ~ Zeu~ dr~n bae~ down
S.Lnce~.eJ.V,
ROGER J. SHAFER, P.E.
RL~/g~
D~S~OSALSTSTEM
DESIGN 17034 EAGLE RIVER LOOP. SUITE 204. EAGLE RIVER, ALASKA 99577
WATER W~LL A~V~$pR~'
HEALTH AUTHORITY APPROVAL NO..~/~
During a recent Health Authority Approval on-si~e inspection and
tes~ 9f .the pptable water supply well on Lot ~ Block ~
of /-~;~ Subdivision, the well's productivity
was determined to be~,J7 gallons per minute. The minimum well
productivity required by this department (AMC 15.55) for
a ~ bedroom residence is~,.~/ gallons per minute.
Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and watering lawns
and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~\(~. ~ '~_.,.~"~
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date November
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
~Lots 9'& 10-Block-3 Henkins T15N R1W Sec.30
1986
Location(addre~ordirections)
Birchwood
(b) Applicant Name Anita Nowak Telephone:Home 688-h11! Business N/A
Applicant Address !56~0 A[de~, Ea$1e River, Alaska 99577
(c) Applicant is (check one): Lending Institution I-I; Owner/builder E3; Buyer I'1; Other I-~ (explain);
(d) Lending Institution Nc~th!~nd Mc)~',t~a~e Telephone 69/4-7872
Address :).2212 O'ld G[enn Hwy EaKle River, Alaska
(e)Real Estate Company and Agent., N/A
Address N/A
(f)
Telephone N/A
Mail the HAA to the following address:
oickuo by en~fneer
TYPE OF RESIDENCE
Single-Family I~ Multi-Family r'l
Number of Bedrooms :>
Other
WATER SUPPLY
Individual Well E1 Community I-I Public D
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite E'I Public r'l Community r'l Holding Tank D
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11,84)
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA m A AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this He;qth
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
Ior 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, Ihe 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
Address
Date II/~/~'~. EAGLE RIVER, AK
P,O, BOX 773294
694-5195
DHEPAPPROVAL ' ~:'
. pproved for, C->bedrooms
Approved ' ~ : '; .Disapproved
Terms of Conditional Appiov'al
""~' '"~ Date
Condiiional ~
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph S above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct 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.
Page 2 of 2
72-025 (1 t/84)
MJNIOPAUW O4~ ANCHOeAGE
Df. pT. ~ Hf. ALTt-I &
~AL eI~OT£CTION
,. w[ LcJ ) vED
MUNICIPALITY OF ANCHORAGE (MO~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:~' "~'~-~'~-~'
Well Classification /,')/~ t V~. r~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~' Date Completed z~.//'..1.3',~' 3 Yield O o 35' ~.~4~ = 5'0¥ (.-~
Cased to ~,',c~
Total Depth
Static Water Level 3o ·
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot ~c ·
Depth of Grouting A///"
Pump Set At ~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots ~'-/~
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
~c'*"f'" e:¢ r' ~"; ; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed /~/~: ~ Size /t~'~;~O ,~'~ NO. of Compartments .,, ~
Standpipes (Y/N) ~ Air-tight Caps (Y/N) ry' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) A'/ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~u"/'., ; for
Holding Tank High-Water Alarm (Y/N) ~'~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well //4~ ~
To Property Line *lo ~
To Water Main/Service Line .t-/o ~'
Course ~ oo ~
Temporary Holding Tank Permit (Y/N)
To Building Foundation .._..~7 !
To Disposal Field .5-"
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Instal led
Width of Field /"~ '
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test "-~"~ ~''
Separation Distance from Absorption Field:
To Water-Supply Well ~-/oo '
Type of System Design
Length of Field ~5'-/
Depth of Field
Gravel Bed Thickness ~' '*'
Standpipes Present (Y/N)
Date of Last Adequacy Test
?
To Property Line ~'/~' /
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course /c~a' ~ ~/~'
To Driveway, Parking Area, or Vehicle Stora.ge Area
Comments '~'
To Existing or Abandoned System on
; On Adjoining Lots f' .?o /
To Cutbank (if present)
,~,.~ t-.
D. LIFT STATION
Date Installed / ~/~,~
SizeinGallons 137 t~r~/ ,,~.,~
'~ ~"/~" Manhole/Access (Y/N)
~ /~',
"Pump On" Level at ~ ~ ~ ~ "Pump Off" Level at
High Water Alarm Level at ~;75- ~ ~ ~- ~ Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Y~ Date //_//"/,~'
Company ~'/~-',-~' MOA No.
Receipt No.
Date of Payment //"/_-//~.) - ~'~'
Amount: $ ~'~
Page 2 of 2
72-026 (11~84)
MUNICIPALITY OF ANCNORAGE
DIVISION OF ENVIRON}tl"-NTAL ItEALTlt
DEPARTMENT OF lt~LTN AND RNVIROb~IENTAL PROTECTIO~I
1. General Information Application Date
(a) Legal Description (include lot, b. lock, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name
Applicants Address
(c) Applicant is (check one) Lending Institution
Buyer[-~; Other[~ (explain);
(d) Lending Institution
Address
(e) Real Estate Co. & Agent
Address
Telephone .
(f) Mail the ItAA to the following address:
2. Type of Residence
Single-Family]~:~
Number of Bedrooms
3. Water Supply
Individual Well~
Telephone - Home
Business
~-~; Owner/builder~;
Telephone
Multi-FamllyF--~ Other (describe}
Public[---]
Note: If com=unity well system, must have ~rritten confir~atiom'from the State
Department of Environmental Conservation attesting to the lesality and status.
,Sewage Disposal
Ousite.~. Public ~--~ C~m~ity ~ Holdl~ Ta~ ~ '
Note: If ~ommunl~y ~11 system, must ~ve ~i~ten co~lma~ton from the S~ate
Depar=men= of Enviro~en=al Conse~a=ion a=tnsCi~ to ~he lngali~y aM s=aCus.
[Page 1 of 2]
En~ineer~n~ Firm Providinz Ins~ec~ions~ Tests~ File Search~ Da~a and Information
As certified by my seal a~fixed hereto a~ as off ~he ~ida~ion ~e sho~ be~o~,
verify tha~ my investi~a~ion of t~s He.th ~t~rl~y Approval sho~ tha~ ~he o~si~e
water supply a~/or ~stewater ~sposal system Is safe, f~ction~ aM ~eq~te for
the number of bedrooms and ~pe oi st~cture /~icat~ herein. I further verify
based on the ldom:ion obCaind fr~ the ~nicipality oi ~choraEe files a~
lnves:itation ~ i~ction, the o~site ~er supply a~/or ~s~eva~er dis~sal
system is In c~pliance ~th ~1 ~nicl~l a~ Sta~e c~es, ordi~ances, a~ reg~a-'
Cio= in effect on the ~e of this inspection.
Address ~o~ ~ /~ '~o~ 'M~ l~ ~
Date ~ OF ~,'%!t
A '-~ ~.
~ ~..'~'.. ..-'~' .'..
. // ..... ,, <...:..<,--/
Approved .~ Disapproved ~ CoMttion~
Ter~s of Co~ditional Approval
CAUTION
TH~ IiUNICIPALITY OF ANOHORAG~ IlEPAR~NT OF HEALTH AND ENVIRO~EhW. AL PROTECTION
(DHEP) ISSUES ltZALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESENT-
ATIONS GIVEN IN PARAG~ 5 ABOVE BY AN INDEPENDENT PROFES'SIONAL ENGINEER REGISTERED
IN TIlE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIE LENDING II~TITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
HENTS.' I~tPLOYEES OF DitEP DO NOT CONDUCT INSPECTION5 OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE ltUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE POR ERRORS
OR OMISSION5 IN THE PROFESSIONAL ENGINEER'S WORK.
RR4/eJ/D18
[Page 2 of 2]
7-19 -84
A. ~ELL ~1%TA
Well Classtfieatio~ /r, ~ ~
TO~I ~p~ ~ ~ ~ ~d ~ ~
S~tic ~ter ~1 '~ ' ~ ~t At
Casing ~ight ~ Gr~ ~,~- '
Elec~i~l ~ri~ in ~it (Y~) /
~ati~ Dis~s ~ ~11:
TO ~pti~ldi~ Ta~ ~ ~t /~m /
To ~st ~ of ~ption Field ~ ~t
To ~est ~blic ~ Li~ ~
~c~P~= o~ ~mo~ (M~) INOV
2
HEALTH AUl~O~/TY A~PROVAL (~)
~ - F~Y 1984
Legal Description:
~f ~, B, = c, D.E.C. ~d(Y~) ~
~ ~,~le~d ~-~3 '~3 Yield
.RECEI.VED
Sanitary Seal on Casir~3 (Y/N)
Dep~ession A=ound Wellhead (Y/N)
; On ~djoining Lots ~/~
/ z g ' ; On Adjoining Lots
To Nearest Public Sewer
Cleancut/Manhole '~- ' To Nearest Sewer Servtoe Line on Lot ~-
Water Sample Collected By
Water Sample Test Bssults ~'<
Y
S~:FrlC/HOLDING TA~( ~I~TA
Date Installed. /~./F ~ Size ,/o~. ~ l, No. cf Ccmpa~ta~nts ~.
Standpipes (Y/N) / Air-tiGht Cap~ (Y/N) ~/ Foundation Clear. ut (Y/N) ~'
De~ession ore= Tank (Y/N) /L; Date ta~t Pumped w~/~ w./~3,
Pu~inG/Maintenanm Cont=act on File (Y/N) /~ ~ fcr -
Noldir~ Tank Hi~-Wate= Alarum (Y/N) ~/~ Tempora~ Holding Ta~ Permit (Y/N) -~'~
_Separation Distances f~cm Septic/}{oldi~g Tank:
To Water-Supply Well
To Proi~rty Line /o
To Weter Main/Se=vi~s Line
Co,.~se /~'~ !
To BuildinG Fcundati~ /o
To Disposal Field ~- w
To Stream, Pond, Lake, (x Major D=ainage
[Page 1 of 2]
%0% t 1'7
2-15-84
C. ABSORPTION FIELD ~TA
Soils ~atinG in A~tion St=ata
Date I~talled /~/4~ ~
width of Field /.1 '
Squa=e Feet of Absorption A~ea Z/-~o ~
Length of Field ~H-- ~
Depth of Field .~ A~ ~
Gravel Bed Thickness ~ ~
Standpipes P~ssent (Y/N)
D. LIFT STATION
Date ID~ talled
Size in Gallons/~P~'
"Pump On" Level at ~ '
High ~ater Alarm Level at
Electrical Codes(Y/N)
Comments
Manhole/Access (Y/N)
#Pum~ Off" Level at
.~-- ~- V~nt (Y/N)
Dimer.~io~m /~ '-- ~ w
Pumping Cycles a~ing Adequacy Test.
** Check Permitted Bed~ocm ~ating Against HAA Bequest
I ~e=tify that I have c~ecked, ~=ified, c~ c~fu~.,'d to all MOA HAA Guidelines in effect
on the date of this
Signsd ~
K~/d5/s
[Page 2 of 21
%"
w.. ~ t~.q~..$$~J~ ...
~,~;:-. ..... .~d'~:'
2-15-84
2018 - 022934 -A
Recording District 301 Anchorage
A 06/22/2018 10:25 AM Page 1 of 3 CCC
111111111111111111111111111111111111111111111111111111111I11I111111111111111101111
GRANT OF EASEMENT
This easement agreement is made between Dustin Freeborn,whose address is 19639 Dels
Lane, Eagle River,Alaska (Grantor), owner of the land described as Lot 10,Block 3,
Henkins Subdivision (herein Property) according to the Plat No. P387, records of the
Anchorage recording District,Third Judicial District,State of Alaska, for a good and
valuable consideration,the receipt whereof is hereby acknowledged, and does hereby
grant unto Dustin Freeborn,whose address is 19639 Dels Lane, Eagle River,Alaska
(Grantor), owner of the land described as Lot 9, Block 3, Henkins Subdivision, according to
the Plat No. P-387 records of the Anchorage recording District, Third Judicial District,State
of Alaska, the following grant of easement: described as:
A perpetual,non-exclusive right of way, to provide access by an area not to exceed
Sixty(60) feet in width for the construction, maintenance,repair,removal and inspection
of a water well and water line servicing exclusively Lot 9, Block 3, Henkins Subdivision,
Eagle River: and
A perpetual right to construct, install, operate,maintain, repair, inspect,use and
remove a water well,including all facilities (eg.casing, pumps,water line and electric line)
needed to operate said well,in, under, upon,about, over and through Lot 10,Block 3,
Henkins Subdivision, Eagle River,Alaska, said well to serve only Lot 9, Block 3 Henkins
Subdivision, Eagle River,Alaska.
Said easement more particularly described as;
An easement depicted on the attached survey prepared by Seward and Associates
Land Surveying, dated 8/31/2010 Recertification,having the dimensions as indicated by
the line data thereon, an area of approximately 3,600 square feet.
1. The easement granted hereby shall not in any manner be dedicated for, or
subject to, use by the public. The use of this easement shall be exclusive to Lot 9,
Block 3, Henkins Subdivision. Within this easement, rock,soil, sand,gravel and
vegetation may be excavated and removed to construct,improve, maintain and
repair the trail area.
2. Grantee may maintain,at Grantee's sole expense,the well access trail
described with particularity above, for the purpose of effectuating the Grant.
Grantor may not place permanent structures over such area or otherwise
make access to the well impracticable.
3. The Easement granted and created is intended to and shall run with the land,
with the benefit of the easement appurtenant to the respective dominant parcel
and the burden of the easement appurtenant to the servient parcel. This
Easement shall be binding and the personal representatives and be perpetual.
4. This Easement shall be governed by,and construed and enforced in accordance
• with the laws of the State of Alaska
SIGNED on this the I 6 day of June 2018
GRANTO : Dustin Freeborn
GRANTEE: Dustin Freeborn
/CC7'
THIRD JUDICIAL DISTRICT ) ss.
STATE OF ALASKA )
The foregoing instrument was acknowledged before me this /1 .day of June 2018,by
Dustin Freeborn, and individual.
' tIOTAq%% %%% 4'0�
Y
n =erg,PUBLIC ,F R NOTARY PUBLIC IN AND FOR THE STA11OF ALASKA
Ak-PS ::
id,
IMy Commission Expires: jJ / S X0-
l,SODOM 3*,.."
THIRD JUDICIAL DISTRICT ) ss.
STATE OF ALASKA )
The foregoing instrument was acknowledged before me this Ir day of June 2018,by
Dustin Freeborn,and individual.
►JOTgA ;�p'4
i A _ i
:' UBLIG RI NOTARY PUBLIC IN AND FOR THE STA11OF ALASKA
°ate.; 0 Al-A�.`' _r
f, C' ck
My Commission Expires: L VI'y
14+ c4Pires:iso
Return to: Dustin Freeborn 19639 Dels Lane, Eagle River,Alaska 99577
111 ,el l IQ1.I':tII1I 1i 1I1111111ILII1 I I1I1111I
Page 2 of 3
2018-022934-0
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o •--=` A$BUILT-NO CORNERS S£7 THIS DATE. SWARD6 � LAE) �9
CO nO= 1 HERESY CERTIFY THAT I HAVE SURVEYED THESCALE' -
to S o FOU.OWINS DESCRIBED PROPERTY*Lot 9 & 10, 1" .- 30' �<0.OF,►h '
ro Block 3 Eenkins Subdivision • DATE2 i 1 .. A, .%P1-4
AM)THAT NO EXIST -i
� ��- INDICATED. IT IS THE RESPONSiBIU THE 6/30/92 i:�:• "� •
1 w= OwNER TO Dkzt.J(MENE THE EXISTENCE OF ANY ORM. i•Of:Y 4 */
o WHICHEASEMENTN6T APPEAR Ott THE Rip SUM-OR RESTRICTIONS NA755 f 4
VISION PLAT. UNDER NO ClRCVMSTANCES IINCULD n2 0 AMA�'Ls / :frt RANY DATA HEREON BE USED FUDR CONSTRUCTIOdN 30-03ta�.�.'•9 •i
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN% l� ,i
ART LINES. b.%......
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