HomeMy WebLinkAboutFISCHER BLK 1 LT 3A7Fischer
Block 1
Lot 3A7
#015-292-12
MUNICIPALITY OF ANCHORAGE r; mok ST 83 O2�
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DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
•I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
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PHONE
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EW
[:]UPGRADE_
MAILING ADDRESS
00 BAlckct
LEGAL DESCRIPTION
Lvf 3 q} Fische. S.,6 I5 -12N -3%V
LOCATION
NO. OF BED OOMS
3 assSt. - not
kl�n cr S'-1A.A
DISTANCE TO:
Well
no� f
AbsorDuon area
Dwelling
n0:•' i1
PERMIT NO
h&ndwnCrL
V Y
Q
Manufacturer
Material 1
S W-
No. ofcompartmentsW
G'IrCCr
N~
Liq. capacity gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Din O
A
DISTANCE TO:
Well
Dwelling
PERMIT NO.
—10Z
_ F
Manufacturer
Material
Liquid capacity in gallons
pWell
—1
ET
DI STANCO:
n� srN
Foundation
n0I' 7n
Nearest lot line
Id
PERMIT N9.
& WA
W
ti Z
No. of lines
Length of each Ijpe
Total length of Bines
Than cn width
Distance between lines
Z W
1
V
Inches
~
Top of tile to finishrade
g I— 3
Material beneath tile
D inches
'vve absorpti n area
Total elfectt��4
b00 d
C~
r..s r
Length Width
Depth
PERMIT NO.
W
112
H
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
to
W
Well
Building foundation
Nearest lot line
a
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT N0.
J
J
W
Building foundation
Sewer line
Septic tank
Absorption arealsl
DISTANCE TO:
OTHER
PIPE MATERIALS
PVG C%
90 TEST RATING
tt
�-� ❑` M1 rIh � - siS{Cd.
INSTALLER
C-a\s 81-010
REMARKS
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GATE LEGAL
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72-013 (Rev. 3/781 1 h s ra'AC& by Y%evt-1 S
MUNICIPALITY OF ANCHORAGE
Department"41f Health and EnvironmentarDrotection
825 .. Street, Anchorage, AK. 09501
264-4720
* * * HANDWRITTEN PERMIT
Permit #a WEL AND ON-SITE SEWER PERMIT
Applicant: 6Qj,v,01-6r Mailing Address:35/a0
Location:,,vv Phone Number: �2`�8^//•
Legal Description:/oT 3,4'1 FsaApe JXcIV IX-1.t.v-_TW Lot Size: V17 -
Type of SoilAb tion System Is:
Trench: ! Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating (sq. ft/br) y160
The Required Size of the Soil Absorption System Is:
'
DEPTH 1� / LENGTH GRAVEL DEPTH r S WIDTH 30
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 = /000 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 W 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 fee
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, 19 3 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 install the system in accordance with codes.
(3) I understand that the on-site sewer system may require nlar ement if
the residence is remodeled to include more tha bedrooem
Signe$: Issued by:
Applicant
Date: /0 83
—TI
SWP/024(1/81)
• C
SOILS LOG
MUNICIPALITY OF ANCHORAGE PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 2643720
SOILS LOG - PERCOLATION TEST InM 67-8.3'0�lY
PERFORMED FOR: Gt•�71U IC �y C�� � _DATE PERFORMED: $'S -b3
LEGAL DESCRIPTION:\SCiYeC S tip Loi -301
SLOPE SITE PLAN
OL
1
2
3
4
5
6
7
8
9
10
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WAS GROUND WATER
ENCOUNTERED?
IF
IF YES, AT WHAT
DEPTH?
Ili N %% 1
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Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
A- 'A
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PERCOLATION RATE 2: s7 /%.Iminut siii � )
TEST?RUNPETWE�1 21 FT AND FT
A
PERFORMED BY: Ui(hPC- CERTIFIED BI
72-008 (6/79)
DATE, 9- ?
r,., WELL LOG
Date Drilled:
Static Water Level DV- feet
Drax Down feet
Tyre Material Drilled:
0 feet to
61
3'f 7 r
Gallons Per Minute
Total Feet of Casing 7
h pert to l4 It t-4
y a • ' - to
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70 . :, ' to I/1)
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ol7�
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
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ohl c cLo rA001
4\rQUtWllil440
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APPLK NT FILLS OUT UPPER HAI" ONLY
TPhone.
Property Owner
G,r,,,/,17MZling
' Zip Codej f 9SU
Address
Buyer .j e. C
Address `l Zip Code
Lending Institution /� v� C. s �`/jetz. j 7' ..
/
Phone
Zip Code
Address
Date
Realty Co. 6 Agent
Phone
Address Zip Code
Inspector
Legal Description .! /� / 3 A `-� 'S t �i {.r 5 s' G J• -
f r
_
/Street � C � •��
Location �-
Type of Residence
6C Single Family /
❑ Multiple Family No. of Bedrooms
❑ Other
— lc,'`d' Ln '�' ECEIVED
( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
Water Supply
Individual
ATTACH WELL LOG. A well log Is rapulred for all walla drilled since June 1975.
.2
Cl Community
For wells trilled prior to that date. give well depth (attach log it available).
❑ Public Utility
Date Sewer Installed Well To Absorption Area
/VT
Sewer Disposal
Individual Year individual Installed:
JR
❑ Public Utility When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
0,.. ,�. r
4+PtN�1 LCCCGI�
Time
TI a
Time
Time
Data
Date
Date
Date
Inspector
Inspector
Inspector
Insp@clor
— e
Field Notes:� p �- MUNICIPALITY OF ANCHORAGE
GC DEPT. OF HEALTH t.
c(C
LV— l.�'�"' ENVIROi' cN ALPR TECTION
C. V' #74U25 Sri 0
�} Z a
�
— lc,'`d' Ln '�' ECEIVED
( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITION APPROVAL'
DATE
BY: — -
Solis Rating
Date Sewer Installed Well To Absorption Area
/VT
Well Log Recelved
Septic Tank Size ((U
Cid 1 ell to Tank Jl��
72 e13 aY '=,' 1/
August. 30, 1983
Grindle & Kroon Company
3400 L'alchen Drive
Anchorage, AK 99503
Subjects Lot 3A7, Fischer Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
A well log submitted to this office for our files and
review.
° The water facilities were not turned on at the time of the
scheduled inspection. Please call this office for another
appointment.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this: office at 264-4720.
Sincerely,
Cory Willis, R.S.
CA17/ej/E2
Parcel I.D. 015-292-12
Municipality of Anchorage `
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: / I - �i - /
Complete legal description FISCHER S/D; BLOCK 1, LOT 3A7
Location (site address) 5141 SELDON CIRCLE "ANCHORAGE, AK
Current Property owner(s) STEVE KLINGER
Mailing address
Real Estate Agent
Day phone 250-6866
5141 SELDON CIRCLE *ANCHORAGE, AK
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
WaiverNariance request for: 1&-/-t l; �o GQcL( Distance: fof o
Received by:
COSA to be released to the
otherwise requested by the engineer.
COSA Fee $ 6@4
Date of Payment 1 12ol_ 115 r.6-•._
Receipt Number del if; v1
COSA # 05C 1513 /
Date:
Waiver Fee $ I ( ?I --
Date of Payment 71a1It-3-
ReceiptNumber O-t"i63G
Waiver# osY15'of8
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 Gayness Engineering Group, Ltd. Phone (907) 337-6179
Address 3701 E. Tudor Rd., Suite 101 Anchorage AK 99507-3246 %%
Engineer's Printed Name Jeffrey A. Garness Date Zil Ar
—
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic
system in accordance with the guidelines and regulations established by the Municipality of
Anchorage and industry practices. The reported results describe the condition of the system/s
on the date/s of the evaluation. Separation distances were measured to readily identifiable
features. Hidden defects or encroachments may exist that were not identified during the
evaluation. The operational life of all wells and septic systems depend on a variety of variables
including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the
year), quality of construction (materials and workmanship), and the water usage of the family
utilizing the systems. These conditions can vary, and are outside the control of GEG.
Satisfactory test results do not guarantee future performance of the systems; therefore, GEG
makes no warranty (express or implied) regarding the future performance of the well or septic
system. GEG makes no representation whether an alternative well or septic system can be
installed on the property in the event either of the current systems fail. The content of this report
is for the sole benefit of the person/party who retained GEG. Reliance upon the information
provided in this report by any other person or party, including but not limited to subsequent
property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other
than the person/party who paid for this report
6. DSD SIGNATURE
-__L� System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
0
bedrooms
bedrooms, with the following
%N`��A�YtOF '1ft
ON-SITE
WATER AND
WASTEWATER
PROGRAM
Original Certificate Date: - '% - /s�
The Iv I ' al+fi✓pffCn ag6 Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work. I -
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA bluesheet 9-1-12.d.c
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: FISCHER S/D; BLOCK 1, LOT 3A7 Parcel ID: 015-292-12
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 8/16/1983 Sanitary seal (YIN) YES
Total depth .275 ft. Cased to 271 ft,
FROM WELL LOG
Date of test 8/16/83
Static water level 241 ft.
Well production 1 g.p.m.
WATER SAMPLE RESULTS
Coliform 0 colonies/100 ml. Nitrate 2.18 mg./L.
Well Log (Y/N) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/26/2015
214
1.96 g.p.m.
Collected by: GEG
Arsenic: ND ug./L. Date of sample: 5/29/15
B. SEPTIC/HOLDING TANK DATA STEEL TANK IS REACHING THE END OF, ITS USEFUL LIFE
Tank Type/Material SEPTIC/STEEL Date installed 5/23/83
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (tY/N) NO / High water alarm (Y/N) N/A
Date of pumping��--1 Pumper (arrn�(
C. ABSORPTION FIELD DATA BELOW EXISTING GRADEI
'Date installed 5/23/83 Soil rating (g.p.d./ft`or /bdrm200 System type DEEP TRENCH
Length 40 ft. Width 2.5 ft. Gravel below pipe 7.5 ft.
Total depth *10.3 ft. Eff. absorption area 600 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/1/15 Results (Pass/Fail) PASS For --!-bedrooms
Fluid depth in absorption field before test E in. Water added 608 gal. New depth 26.5in.
Elapsed Time: 1135 min. Final fluid depth 14.5 in. Absorption rate >= 450+ g.p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date —
D. LIFT STATION
Date installed Size in gallons ManholelAccess
°Pump on" level at in. 'Pump off"
E. SEPARATION DISTANCES
level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot *90 On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
Public sewer manhole/cleanout 100'+
Holding tank N/A
Animal containment areas --N '+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *8'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, paridng/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 10(Y+
F. COMMENTS "
*SEE ATTACHED WAIVER REQUEST'S
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
data.
Engineer's Printed Name JEFFREY A. GARNESS
Data 4129YY
(Rev. 11/05)
ai
5'59°5G'9d"4 9773
,569 "53' ID -i4l
55L D ii'✓
s
kY u.
1.491
LESLIE L BRATFA
U4
!h
39. ea U
O
h
30'
'1
i
SCALE
I HEREEY CERTIFY THAT AN ACCURATE SURVEY
CF THE FOLLCWING DESCRIBED PRCPE3TY,
3 7
fLO,T3
P' a'3
PREPARED
FOR:
�i
WAS MADE ONU9f/57` Z/o, X57, AND THAT THE,
IMPROVEMENTS SITUATED THEREON ARE WITHIN THE
PROPERTY LINES AND 00 MOT OVERLAP OR ENCROACH
�>7 ���+
T
cii Tie MPM-17 LYING I:..;A=MT TAE:t= R� TNi7
i7
` -1
No IMPROVEMENTS LYING ADJACENT THERETO ENCROACH
DAN. CR
FILE N0.
9&1
ON THE PREMISES IN QUESTION AND THAT THERE ARE
:HK.
SRID7537
NO ROADWAYS, TRANSMISSION LINES OR OTHER VISIBLE
Nip
J�Glfihi
EASEMENTS ON SAID PRS EXCEPT AS SHO N.
us
RE'G_i1144
A
,.ui.x,enu.vevo.,
ANCHORAGE. ALASKA. THIS✓MS DAY OP 7583.
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i
SCALE
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Municipality of Anchorage
Development Services Division
On -Site Water and Wastewater Program
.meat. s,
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Mee pai•tment
**** VARIANCEIWAIVER REVIEW ****
Waiver#: OSV151089 COSAM OSP151384 Permit#:
PID#: 015-29242
Legal Description Fischer Block 1 -Lot 3A7
Engineer: Garness Engineering Group
Applicant: Steve Klinaer
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 90.0 feet. In addition,
the existing field is approved to be 8 feet from the property line.
This waiver approval applies to the existing septic 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.
M The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
Adjacent properties are notaffected by this waiver.
.............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: Approved by: d /'
Name of Reviewer
............................................................� .. ..............
*** VARIANCEMAIVER REVIEW ****
Fischer Block 1 Lot 3A7
Parcel ID: 015-292-12
Waiver for 90 feet from tank to well
8/4/2015
General
1. The well and septic tank are on opposite sides of the house.
2. Lab results show nitrate levels to be 2.18 mg/I.
ADEC Criteria Points
Water Table
Depth to water bearing layer 268 feet
Depth of tank 10 feet
258 feet 7.8
Soil Sorption (no well log loo from Lot 42B used)
Soil descriptions
Permeability
Soil descriptions (no well log, log from Lot 42B used)
DEC PTS
Depth From
Depth To
Thickness
Calc. Pts
sand/gravel
0.8
10
30
20
0.06
clay - gravel - sand
4.5
30
42
12
0.21
sand
1.5
42
48
6
0.03
gravel - sand
0.8
48
70
22
0.07
gravel - clay
3
70
110
40
0.47
gravel
0
110
200
90
0.00
Cemnted sand/grav
3
200
268
68
0.79
258
1.63
* A large portion of the
soils has 3 pts or larger, use 3 for
the value.
3.0
Permeability
Soil descriptions (no well log, log from Lot 42B used)
As per ADEC waiver guidelines, with a minimum point value of 14.4, no bacteriological pollution possible
but chemical pollution possible but unlikely from household chemicals.
DEC PTS
Depth From
Depth To
Thickness
Calc. Pts
sand/gravel
1
10
30
20
0.08
clay - gravel - sand
0.5
30
42
12
0.02
sand
1.5
42
48
6
0.03
gravel - sand
1
48
70
22
0.09
gravel - clay
0
70
110
40
0.00
gravel
0
110
200
90
0.00
Cemnted sand/grav
0
200
268
68
0.00
258
0.22
A large portion of the soils has 1 pt or larger,
use 1 for the
value.
1.0
Water Table Gradient -
Not calculated
Horizontal Separation
90 feet
2.6
Total Points 14.4
As per ADEC waiver guidelines, with a minimum point value of 14.4, no bacteriological pollution possible
but chemical pollution possible but unlikely from household chemicals.
GARNESS ENGINEERING GROUP, Ltd
•_ - CIVIL & ENVIRONMENTAL ENGINEERS�-
June 29, 2015
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Waiver Request for Fischer S/D; Block 1, Lot 3A7
To whom it may concern:
The existing well is approximately 90'from the existing septic tank (see as -built survey). We are requesting
that your department issue a 90 foot waiver between the existing well & septic tank. Also, the existing
drainfield is approximately 8' from the property line (see as -built survey). We are requesting your
department issue an 8 foot waiver between the existing drainfield and the property line. Comments
supporting the waiver request are listed below:
• The well and septic system are on opposite sides of the house. If effluent were to surface, it would be
unable to travel back towards the well head.
• Attached is the well log for the referenced property. The well depth is 271 feet. The soil appears to be
a variation of gravel, sand and clays.
• We are only asking for a 10% variance.
• Recent water samples results indicated no bacteria present and nitrate levels to be 2.18 mg/l. In short,
the water quality is within MOA, state, and EPA requirements.
• The tank to well encroachment has existed for 32 years.
• The drainfield is not within 10' of the drainfield on the adjacent lot
• The drainfield to lot line encroachment has existed for 32 years.
In short there is minimal risk associated with the grating of this waiver.
We are unaware of any adverse impacts this wavier would have on adjacent wells or septic systems. If you
have any questions, please contact us at 337-6179. Thank you for your assistance.
M.S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507.1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
Page 1 of 1
Wockenfuss, Deborah M.
From: Jeff Garness [Jeff@garnessengineering.com]
Sent: Monday, August 03, 2015 1:05 PM
To: Wockenfuss, Deborah M.; Poet, Jeff W.
Cc: David Garness
Subject: Fischer Subdivision, 131, 3A7 - Waiver between well and septic tank
Hello Debbie and Jeff,
I had David go to the subject property today. He measured 112" from the top of ST2 pipe to the bottom of the
tank and 64" from the top of ST2 pipe to the top of the liquid. This corresponds to a tank liquid depth of 48
inches. In short, the septic tank appears to be operating within the normal operating level of a standard septic
tank (around 49").
Please call or email if you have any questions.
Best Regards....................jeff
Jeffrey A Garness, P.E., M.S.
President
Garness Engineering Group, Ltd
3701 East Tudor Road, Suite 101
Anchorage, Alaska 99507
Ph: (907) 337-6179
Cell: (907) 244-9612
Fax: (907) 338-3246
Website: www.garnessengineering.com
8/4/2015
Ment
MUNICIPALITY OF ANCHORAGE
Community Development Department q
Right of Way Section "
epartment
ENCROACHMENT PERMIT R151874
THIS AGREEMENT, made this 8th day of July, 2015, by and between Steven L. Klingler and
their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of
Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State
of Alaska, hereinafter called the "PERMITTER".
WITNESSETH:
WHEREAS, PERMITTEE is the owner of the following described real property:
FISCHER, BLOCK 1, LOT 3A7, according to the official records thereof, on file in the
office of the District Recorder, Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows:
The 10 FOOT UTILITY EASEMENT, located on the north portion of PERMITTEES
property as shown on Plat No. 70-0170, on file in the office of the District Recorder,
Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTEE has placed a well casing upon the referenced real property which
encroaches approximately 3 feet upon the PERMITTER'S 10 foot Utility Easement.
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
1. The PERMITTER, acting through the Director of Community Development
Department, hereby grants to the PERMITTEE the privilege of allowing a well
casing to encroach approximately 3 feet upon the PERMITTER'S 10 foot Utility
Easement, as shown on "Attachment A," included herewith.
2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless,
the Municipality, its officers and employees, from any and all lawsuits, claims or
actions brought to any person for or on account of damage to property or injury,
disease, illness or death of persons, including all costs and expenses incident
thereto, arising wholly or in part from or in connection with the existence of,
alterations, maintenance, repair, renewal, reconstruction, operation, use or
removal of the encroaching well casing, as placed upon the PERMITTER'S
Utility Easement.
3. The PERMITTEE shall not assign or transfer any of the rights granted herein to
another individual or company without fust notifying and securing the approval
of the Director of Community Development Department.
4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S
real property whatsoever, except only the encroachment rights described herein.
5. The PERMITTER reserves the right to revoke this permit upon twenty (20)
days written notice to the PERMITTEE. The PERMITTEE agrees upon such
notice of revocation, to move said encroachment(s) from the Utility Easement
in which it is placed. Should the PERMITTEE refuse or fail to comply with
said written notice, the PERMITTER may, without further notice to the
PERMITTEE, remove or cause to be removed the encroachment(s), and the
PERMITTEE hereby agrees to reimburse the PERMITTER for all costs
incidental to the removal thereof.
In addition to the mutual promises heretofore made, the PERMITTEE has paid the
PERMITTER a one-time permit application fee of $115.00. The PERMITTER hereby waives the
annual fee of $300.00.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day
and year first hereinabove written.
GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE
teven L. Klin &, , owner 6_&L, Frost, Jr.
Right of Way Supervisor
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this Q}h day of 2015, before
me, the undersigned, a Notary Public in and for the State of Alaska, du y commissioned and sworn as
such, personally appeared Jack L. Frost, Jr., known to me to be the Right of Way Supervisor for the
Municipality of Anchorage, Alaska, who executed the foregoing instrument, and he acknowledged to
me that he executed said instrument as the free and voluntary act and deed of said corporation for the
uses and purposes therein mentioned, and that he was authorized to execute said instrument.
WITNESS my hand and official seal on the day and year first above written.
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
NOTARY PUBLIC in and for Alaska
My Commission Expires:g h (k'7
) ss.
THIS IS TO CERTIFY that on this 3t ' day of 4AA.� , 2015, before
me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as
such, personally appeared Steven L. Klingler, known to me to be the individual named herein who
executed the foregoing instrument, and he acknowledged that he did so freely and voluntarily for the
used and purposes therein mentioned, and on oath stated that he was authorized to execute said
instrument.
WITNESS my hand and official seal on the day and year first above written.
NOTARY PUBLIC in and for Alaska
My Commission Expires: q li I.In
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POST IN A CONSPICUOUS PLACE
ALL WORK MUST BE INSPECTED
Field Inspection Request required 2 working days in advance of starting work
and 2 working days in advance for final inspection. Call (907) 343-8206
(voice recorder) for scheduling. Permit is not valid without the call-in and also
must include the one -call ticket (utility locate) number.
MUNICIPALITY OF ANCHORAGE
RIGHT OF WAY DIVISION
RIGHT OF W
I ype:
Construction Stark
;151874
7/8/2015
PWDEW
/d812015
See reverse for requirementsiremarks.
I have read and understand both sides of this permit. 1 agree to the terms and conditions; and 1 certify that all work will
comply with federal, state, and municipal codes and regulations and the provisions of this permit.
Signature: L,Date_ °fj t s
