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Home My WebLink AboutT12N R4W SEC 10 LT 45 W2T12N R4W Sec 10 Lot 45 W2 #011-201-18 Municipality of Anchorage (_ Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of T-- www d anchorage ak us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 5Wj27(?Q1-D PID Number. I I ^ 2v I— I i! "re'.tJin 4GoFrn G;/1164 'C Wastewater System: [YNew C3Upgrade Adl ABSORPTION FIELD plan. 7-?7 ,� � v ' dia �' l;T wTlerc/, D Serve Trvxll DEW O Maus 0011W LEGAL DESCRIPTION sa Pe ,,g (r 2 TOW ppm nam arpw ped GPD/F!" eiu LAX 51ee,ean N� Dem 1, Pipe t"xUxn from 1)"'" 11 Gmal aroma mpp Zi SIs� 7,15'Fl. 61'9 FI To nenp /R^�enpe `` s.a.al, Fe tiaaea elx vs wg.n pea G GIM Laepm '1O Z K (IV V — O Fl. Fl. Well: MNew ❑ Upgrade GreMlwam 710 w.w.al.W ci o awe«, M,n FI. Ft CM.N,aepn IPrnele. A B. Q T" Daae, Cnaa m TOW ebwrpt a tine PP"itm n 7.9- 2— Ft. Z'Z Ft C% 7 2 D Ft ({ a,0,> Di OMe c} suimwt,.Lh lr W DIIe Mgel l 'i V r'L Ft Q, t t Y� Perp SWM Cearp Hearn Apay. Gmub TANK cpM Ft. / Ft SEPARATION DISTANCES fASeptic []Holding ❑S.T.E.P. ❑Other. To Septic Absorption Lift Holding meteI• w n From Field Station Tank Sewn Line SewLine A p / t f7 Gn M" root rood MwwW eaaao.aCaanuxn.au s.tiaw«. roe'+ lop'4 LIFT STATION La Lln. xV' f- 5'r- Gr eouw 'P,nV On MMI M 'PIa,V air Mel 1•al, wanr ewm til FpMeOan S!' f• zJ' m m m C~ pr, Mage 8 M F: ENaacal MlaoerLaro p.aamea aT Remrb �-o � ( � BENCH MARK r walMna rd Laalgn tirla O.aupeaa YRMa .WYOrt FL M /A Gt c An:.L flel Dates: 1 r ?7 Inspections performed by: >I.� ,Z'!!t OF Al 1.1 2n° rt 7 ,r ,`p,.........; �s 11 Development Services Department Approval �* *k 91r� 9TH Conditional Approval Date: .:. ::' ✓ F�0 MICHAEL N. ANDER.CN : `>• 4Date: � CE 9869 � Reviewed and approved b : ? .3 � (Rev F l• FES 4` Permit No. SW070030 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: T12N, R4W, SECTION 10, WEST 1/2 LOT 45. PID No.: 011-201-18 MARK A 8 '� ELEY. PIPE ELEV. . \ rco ss 1a 10 s 9z1 ' \ C01 37 10 9 .2 923 w ! WEST 1/2 4e TCOt 58 10 9 .S i Baa C04 47 S2 93.7 TCO2 S3 10 98.4 It BLM LOT 45 �I CO2 48 15 98 91.8 ® MT 48 I I 1 O / � U / \ \ Z. LJ / io / N \ / n \ / N � •- BENCH, TQ OF CONCRETE Sl/18 _ i� LO o z bn O �' N TEST LE RADIUS FCO. \ j 9 00 . I CO2 I ,SQZII I I / II n A ' —h uT u IF 132.52' ASBUILT SCALE: 1'=50' .CO M 10]1 ,CO] •• ,•• \ li ........... ....,, • (�\ �. 49/TM...••• '•"° °"'"" �� r ♦ *-'.MICHAEL N. ANDERSON;JV gnu T. �� mv No. C 9469 • �1y. ��.1y1.� MO MlO • xT$ -1�0 N1 r 4e 9o.s i Baa C04 47 S2 93.7 D0.3 Performed For. Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www a anchors a k.usi anchorage ek.us (907) 343-7904 Soils Log - Percolation Test �91 0. 7 1 C :MICHAEL N. ANDERSON ,'q, sjF•• C? 69 • ��i �19fn:••.. 8...•�y.`�.. OCPA 4`k'dV'Cr7 L-)/�h & Date Performed: Q'/Z T't � K 44k.i S -r At," /D Township, Range, Section: c�`"`ys Slope� CLI-T— %o4*M(. g _T CJ VVI(tj COMMENTS Al WAS GROUND WATER Date Gross Time ENCOUNTERED? Depth to Water Net Drop _110 S IF YES. AT WHAT DEPTH? L Depth to Water After O P Monkorlrg? A PIC, V A Dale 2 D XG Oitsa• (.v T Reading Date Gross Time Net Time Depth to Water Net Drop V A S L G" %z %i to PERCOLATION RATE 7S• (m ewirn) PERC HOLE DIAMETER iI TEST RUN SETWEEIj Af FT AND S— FT PERFORMED BY: f!// A % I et 4 On I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2 00 t Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Program `o Ment 1^ C Department **** VARIANCE/WAIVER REVIEW **** WR#: 090048 HA#: _ Permit#: SW070030 PID#: 011-201-18 Legal Description: T12N R4W Sec 10 Lot 45W2 Engineer: Mike N. Anderson Applicant: Karn Gillis Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 6.0 feet. This waiver approval applies to the existing absorption field to property line separation 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.......................... Waiver is Granted: X Waiver is not Granted: Date: 8/13/2009 Approved by: ✓% Name of Reviewer ............................................................................... Rec#: 001225 Amount: $200.00 Date Paid: 8/12/09 **** VARIANCEIWAIVER REVIEW **** rgGtt : r-i—ol!e DPILLIhu FW NO. : 907 345 02= Dec. 15 2007 t2:16PM P: ,tigt tuti.t ALPINE DRILLING & ENTERPRISES Permit Number, 4SA'070030 Date of Issuc: 4-04-07 Parcel Identification Number.011-201-18 Date Started: 12-1"7 Date Completed.- ,,"2-07 is well located at approved permit location? ® Yes Q No Legal Description: T12N R3W 1 r 4 4V2 Property GemtrName do Address: Karen b Von) Gillis 705 Chrfstlanson A_..w...w - Ah.G. 0094A Attention: Mie wall driller shall provide a well log to the property owner within 30 days of completion and the property owner or the well drilla shall provide a well log to the DnclopmetN Services Department aid in 60 days ofeompletirnl _ Borehole Data- Depth (ft) Method of Drilling ® air rotary ❑ cable pool Sail Type, nkliners 8: U;3!u Strata From To Casing lupe: eel i stick-up 0 2 Wall Thickness: jW inches exganies 8 s:R 2 3 Diameter: 6 inches D �pth: 2-72 feet silty sand/ gravel 3 47 Liner Type: _ Diameter' inches Depth: _ feet gravelly silt 47 1110 Casing stickup above ground*,Z feet yg 180 223 Static water level (from ground level): ?-4 feet i silty gravel 223 265 Pumping levcl:-gafeet after water sand & gravel 265 272 Z hours puuaping 10 Zpm Recovery Rate: jQ spa: Method of Testing irl- Well Intake Opening Type: ® Open End ® Open Hole ❑ Screened Stmt _ feet Stopped _ feet ❑ Perforations Stars _ feet Stopped — feet Grout Type: beprionlie granit Volume: 2 j Depth: Start o feet Sropped 2 feet Pump: Intake Depth^ fat Purrip size hp, Brand Name Well Disinfected Upon Completion? ® Yes [] No i Method of Disinfection: ehlorirre tehlEt� Comments: Well Driller: Alpine Drifting & Entorprises P.O. Box 170496 Anchorage, AK 99511-0496 Attention: Mie wall driller shall provide a well log to the property owner within 30 days of completion and the property owner or the well drilla shall provide a well log to the DnclopmetN Services Department aid in 60 days ofeompletirnl SGS ReLM 1092486001 Client'Name Gillis. Karcn Project Name/H 5090-88 Client Sample ID 5090 W. 88th Matrix Drinking Water P%%SIU 0 Printed Date/1"ime 06/16/2009 16:59 Collected Date/fine 06'08'2009 11:55 Received Date/fime 061087009 12:05 Technical Director Stephen C. Fade Sample Remarks: Alloeahlc Prep Analysis Parameter Results PQL Units Method Container I Limits Date Date Init Metals by ICP/MS Total Nitrate/Nitrite-N ND 0.100 Arxnic NRII 14.1 • 5.00 Waters Department [1'200.8 Total Nitrate/Nitrite-N ND 0.100 Microbiology Laboratory NRII Colony Count 0 '1 otal Cohfurm 0 Fecal Coliform 0 ug/l. [1'200.8 C (<10) 06/09'09 06/11/09 NRII mg/l. S%120450ONO3-1' 11 (<10) 06/12/09 LCE col/100ml. S\120922213 A (<200) col/100ml. S\120922211 A (<I) col/100ml. SM20922211 A (<I) 06/08/09 SDP 06/08/09 SUI' 06/08/09 SDI' 111=60' BLM LOT 45 LOCATED WITHIN THE SWI/4 SECTION 10, T12N, R4W, S.M., ALASKA 33' BLM ROAD1h RESERVATION on I I I I 33' BLM ROADWAY RESERVATION 132.41' — WEST 1/2 BLM LOT 45 WELL 'deo \s� 132.52' To N n N 3 N o. SEPTC n SYSTEM 16 WEST 88TH AVENUE ee•�� 165.41' M I I I EAST 1/2 BLM LOT 45 —i_ _ 165_53' S 89.54'19"E LEGEND FOUND 5/8" REBAR STAMPED "LS-60911- 0 LS-6091"• FOUND REBAR WITH YELLOW PLASTIC 1 CAP STAMPED "LANTECH" 1 i 6 FOUND BRASS CAP MONUMENT O SET 5/8" REBAR WITH YELLOW PLASTIC OND BLVD. CAP STAMPED "LS -6091" OF AZ AV •.4 . ........... I......... ; . ' Jeffery A. Gaetaldi ♦ '� 6091 X Ar Pote3sion 10 AS- GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.LS. 2000 E. DOWLING RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID DATE 2324 4/16/2009 F.B. JOB NO. 08-06 BLM45 x CALCULATED POINT, NOTHING FOUND OR SET I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE NO CORNERS SET THIS DATE BUILDING DETAIL SCALE: 1 "=20' MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Renewal Permit Number: SWO80025 Legal Description: T12N R4W SEC 10 LT 45 W2 Design Engineer: 0088 ANDERSON CONSTRUCTION & E Owner Name: KAREN GILLIS Owner Address: 705 CHRISTIANSON DRIVE ANCHORAGE. AK 99515 - Date Issued: Apr 07, 2008 Expiration Date: Apr 07, 2009 Parcel ID: 011-201-18 Site Address: Lot Size: 54711 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of. 0 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO CONSTRUCTION OF THE SEPTIC FIELD. THE PERCOLATION TEST PROCEDURE IS TO FOLLOW TABLE 3-8 OF THE EPA DESIGN MANUAL. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL. Received By Issued By: Date: '04 Date: T �\ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 011-Ac)I- is Prope rt Mailing y owner(s) KC�VP� �� ( l�� S Day phone Lo St I *-1 address 11 I TC l }� �L� Zip Code _ng' l I Site address 51A) i_ Oo I " AVS Zip Code Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size 94 �3"1 I Sq. Ft. Number of Bedrooms N THIS APPLICATION IS FOR (Z all that apply): THIS APPLICATION IS AN: Absorption Field Q_ Initial ❑ Septic Tank D' Upgrade ❑ Holding Tank ❑ Renewal 12 Privy ❑ Private Well [� Water Storage ❑ I certify thatabove information is correct. I further certify that this application is being made for a Single Fatuity welling and is I ccord�ce-lh_applicable Municipal Codes. of property owner or authorized agent) Permit/Rush Fees: 1 ce+ Waiver Fees: DC7 Date of Payment: H I�0 Date of Payment: d (J ' OOra�s Receipt Number. ��.��'' Receipt Number. (Rev. 11105) MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW070030 Legal Description: TI 2N R4W SEC 10 LT 45 W2 Design Engineer: 0088 ANDERSON CONSTRUCTION & E Owner Name: KAREN GILLIS Owner Address: 705 CHRISTIANSON DRIVE ANCHORAGE, AK 99515 - Date Issued: Apr 04, 2007 Expiration Date: Apr 03, 2008 Parcel ID: 011-201-18 Site Address: Lot Size: 54711 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑V Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO CONSTRUCTION OF THE SEPTIC FIELD. THE PERCOLATION TEST PROCEDURE IS TO FOLLOW TABLE 3.8 OF THE EPA DESIGN MANUAL. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL. Received By: Date: N 0 aE i I[.i7L•I/. / 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 w%mw.muni.org/onsite (907)343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O) I -2-01' 1 `) 5 9 T I Property owner(s)N k a,V e✓1 0 ��i S 7� Day phone a '?V - hS7 9 Mailing address �f(>5 /7!�((Cl r7• rd1�• Zip Code Site address Code Legal description (Sub'd, Block & Lot) T 12 h(, (`f Int 5r2� /J, Legal description (Township, Section & Range) Lot Size 5q, 1/1 Sq. Ft. THIS APPLICATION IS FOR (gall that apply): Absorption Field 91 Septic Tank iZ Holding Tank ❑ Privy ❑ Private Well Water Storage Number of Bedrooms THIS APPLICATION IS AN: Initial M Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 63 Waiver Fees: Date of Payment: � _/!j — O 7 Date of Payment: Receipt Number: �� Receipt Number: (Rev. 11/05) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4640 Shoshone Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 April 4, 2007 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: T12N, R4W, Section 10, West %: of BLM Lot 45 To Whom it may concern: The drawings have been revised to show the PROPOSED well location not existing ... and the existing slope drainage arrows have been corrected to match letter. Now the trenches are parallel to the slope of the lot. The percolation test will be updated when the system is installed, a new perc will be completed showing a minimum of 6 readings. If you have any question please call me at 345-3377 Sincerely Mic ael . Anderson, P.E. Michael N. Anderson, P.E. Civil/Structural Engineering R Construction 4640 Shoshone Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 February 2, 2007 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: T12N, R4W, Section 10, West % of BLM Lot 45 To Whom it may concern: This is a request for a new septic and well permit. The test hole excavation was completed near the south end of the property, the soils consisted of poorly graded sands and gravels for the entire test hole depth, to the bottom of the hole at 16 feet. Water was not observed during the excavation or after the 7 day monitoring period. The perc rate was 2 minutes per inch. A new 5 wide trench will be utilized for the leach field with an effective depth of 4 feet. The application rate of 1.2 gallons per day per square foot has been used for the 5 wide trench for a total length of 50 feet. A reserve system has been shown on the plan. The lot is very flat maybe 1 to 2 percent from the north end to the south side. The neighboring lots will NOT be impacted by this new construction due to public water or vacant lots, see plan. If you have any question please call me at 345-3377 Sinc/�' , /✓/��v Michael N. Anderson, P.E. DESIGN CRITERIA: /MOUND OVER (THJI) b / GRADE 4 BDRM X 150 = 600 GPD ORG _10 SOILS = 600/1.2 = 500 GPD FILTER FABRIC 500 GPD/5 X 2 = 50' 4'0 PIPE -3.0- (1) TRENCH SW SEWER ROCK 7.0' DEEP 4.0' EFFECTIVE 5.0' WIDE 5.0' 50' LONG -16 1 1 1 1 � 1 1 \ N / ' O r ----- WELL _100' RADIUS -WEST 88ti/H A V E N U E- �I" PROPERTY LINE i / ♦ � 1 1 1 • I '- w WE 14 PICO /k PROPOSED 4 BEDROOM HOUSE U� ' O U PROPOSED SEPTIC EJ El _ / IVR PUgUC WA ` ' SCott ) VACANT VACANT (CITY CITY PARK Septic Design Prepared For •��, VERN & KAREN GILLIS �0�. WEST 1/2 BUI LOT 45, SECTION 10, T12N, R4W :OP�E•�....••. • �j..•'' �. Anchorage, Alaska o •• •' • ••• ....... .0 �' Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE _ '•.�/X: ...; . i MICHAEL N. ANDERSONe�C (907) 345-3377 / FAX (907) 345-1391�#� No. E 469 SCALE: 1'=100' APRIL 4, 2007 x, •• , WELL DRIVEWAY �+ PROPOSED 4 W BEDROOM HOUSE N H p N O J U c _DOUBLE z e i e ` PROPOS mac--- GALLON MT'� 32.6' C,D.r�------------- ----------- THII 1-21 , r-------- ------- �z3 /1\\L------ -------- 1-27 2U u a C.O. :D 2,D00 1-27 SEPTIC TANK 11 C.O. PROPOSED PRIMARY DRAINFIELD 0 1-21 PROPOSED RESERVE DRAINFIELD .O p'R1Q Septic Design Prepared For VERN & KAREN GILLIS WEST 1/2 DLDS LOT 45, SECTION 10, T12N, R4W Anchorage, Alaska Prepared By MICHAEL N. ANDERSON, P.E. 4640 SIIOSIIONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' APRIL 4, 2007 "'I 49TH IAEL N. No. CE LINE 0 Performed For: Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 1966W Anchorage, AK 99579.6650 www cianchoraae.ak.us (907) 343-7904 Solis Log - Percolation Test ea r•e r) , . (a •, 1h S __Dale Pedo W 1/ g LM1-9i o15' Township, Range, Section: 'L 5ZL /UST/ZA(I Ry Slope •r ere=.�.cy 2 1 TJ G 4- . 5- rr 6-lZrave 8- Date Gross Time Net Time DepthyWaler WAS GROUND WATER 9- l 27 viO'HO ENCOUNTERED? s 10- Q�rb0a IF YES, AT WHAT DEPTH? L O Depth to Water After /Dhd Moniloriny7 E 11- " b 12- Date 13- 14- 15- 16- '41 17- 18- 19- 20 - COMMENTS .tom �. lt,.�yw.•w.L�� T y�P,•• •, y111 '7s' MICHAEL N. ANDERSCN :'A: P CE -9469 •:;�,i &7 Reading Date Gross Time Net Time DepthyWaler Net Drop l 27 viO'HO /O.n Q�rb0a ro0"P(r!� " b Ir -e Gey " PERCOLATION RATE (, FERC HOLE DIAAIETCR (/ TEST RUN BETWEEN :�j Fi AVD A-/ FT PERFORMED BY: M %r 6 r l � ►^ J_ ev h°n- 1 CERTIFY THAT THIS TEST AS PERFORMED IN ACCORDANCE WITH ALLSTATE ANOMUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /N D