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CALAIS BLK 3 LT 4
Calais Block 3 Lot 4 #009-034-35 Municipality of Anchorage •- Development Services Department :� ��• • Building Safety Division i . • . On -Site Water 8 Wastewater Program 4700 Bragaw Street /^ / P.O. Box 196650/ ✓� t� • Anchorage, AK 99519519 650 L Id/"�✓ www.muni.org/onsite (907) 343-7904 / CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 009-03-435 COSA# 1. GENERAL INFORMATION Expiration Date: 7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CALAIS BLOCK 3 LOT 4 3002 EUREKA STREET *ANCHORAGE, AK 99503 DANIEL do MELY GIBBONEY Day phone C/0 AGENT 3002 EUREKA STREET "ANCHORAGE AK 99503 Day phone MARY STEPHENS W/ PRUDENTIAL Day phone 273-7706 3801 CENTERPOINT DR 0200 *ANCHORAGE, AK Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site 0 Public Water System ❑ 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date / zo 0 It Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering anatysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will R confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: OFgjy�y0 ONVE •�(tfWggrERAND ;EYVATER : PROGRAM •, '...,...Hunt Attachments: COSA Checklist VIL Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nita Advisory J Other B • l Original Certificate Date: (R•v. 7 LOS( \ [Municipality of Anchorage --1 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 0 Legal Description: CALAIS BLOCK 3, LOT 4 Parcel ID: 009-03-435 A. WELL DATA *PER 1985 QUADRA ENGINEERING REPORT Well type PRUATE If A, B, or C provide PWSID# N/A Date completed PRE -1962 Sanitary seal (YIN) YES Total depth 41+ ft. Cased to '40+ ft, FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform __�L colonies/100 ml. Arsenic:/7,6 ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments _ Foundation cleanout (Y/N) _ Depression over tank (Y/N)- Dat ft. g.p.m. Well Log (YIN) NO Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 1/14/10 24 ft. 6.55 g.p.m. Nitrate (2,L_mg./L Other bacteria ` � coloniesll00 ml. Date of sample: 1/13/10 Collected by: GEG Ltd. PUBLIC SEWER e installed Cleanouts(YIN) High water alarm Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./feor ft'/bd System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption a_ ft' Monitoring tube_ Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in abso ' n field before test in. Water added _gal New depth _in. Elapsed T' _ min. Final fluid depth— in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date – D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main Sewer /septic service line 25'+ Public sewer manhole/cleanout •100'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line Absorption Water service line Surface water. SEPARATION DISTANCE FROM ABSORPTION Property line , 'r ound Water service line Surface water F. COMMENTS Wells on adjacent lots TO: Water main Driveway, parking/vehicle storage *REQUIRED SEPARATION DISTANCE WAS ONLY 50' WHEN INSTALLED. G. ENGINEER'S CERTIFICATION o OF. I certify that 1 have determined through field inspections and a !' `..J ' ^ YA V,review of Municipal records that the above systems are in ""."' .. ' ' "' """' .. conformance with MOA COSA guidelines in effect on this date. J Ga ess: Engineer's Printed Name JEFFREY A. GARNESS QQO CIE -7953 : r FvpO Date 1/20 /110 ���e a 20.�Ib''��A� —/ �0 dp�oression0\ ��OO000�� COSA Fee $ —7 / U Date of Payment_1 ��7-o l o Receipt Number C1 -2-3U (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SCS RcEN Client Name Project Name/N Client Sample ID Matrix Sample Rcmarks: 1100206001 Garncss Engineering Group, Ltd Calais L4 D3 Calais L4 D3 Drinking Water Printed DateMme Collected Dsterrime Recehtd Date/Time Technical Director 01272010 11:39 01202010 13:00 01202010 13:15 Stephen C. Ede Allowable Prep Analysis Parameter ResulLs LOQ Units Method Container ID Limits Date Date [nit Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 0 cot/l00mL SM209222D A (<200) 0121/10 SDP 0 col/100mL SM209222B A (<I) 0121/10 SDP 0 coV100mL SM209222D A (<I) 0121/10 SDP SGS RAO 1100130001 Client Name Gamcss Engineering Group, Ltd Project Name/N Calais SID L4 B3 Client Sample ID Calais SID L4 B3 Ntatria Drinking Water Printed Dateffime 01/19/2010 16:08 Collected Datefrime 01/13/2010 10:23 Received Date rime 01/13/2010 10:47 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Paramct" Results LOQ Units Method Container ID Limits Date Dale Init Metals by SCP/H3 Amnic 17.5 + 5.00 Waters Department Total Nitmtc/Nitritc-N 0.100 U 0.100 Microbiology Laboratory Total Coliform Negative I E. Coli Negative I Page 2 of 4 ug/L EP200.8 C (<10) 01/13/10 01/19/10 NRB mg/L S%120450ONO3-F R (<10) 01/19/10 LCE IOOml. SM209223B A IOOmL SM209223B A 01/13/10 SDP 01/13/10 SDP 9075625485 Prudentlal Jack Whlte/VI J3:° :� .MOITUI01.39w: pn GUILD M RT. INC 18:03:33 01-11-2010 2/2 FAX N0, Mew P'2/ra 03 1 " SOT 5 al 69042'3046 ,I O d Qa I I 1 Zi 8!W J I . rn0use_ ;4% S 69'49' ' mW 1/4.63' T /0= :GOT 3 D nAm O Lot .4 , Block •'3 CWC7/3' SUbdiVlSion ' ... ' Ancnoroge Recording District, Alaska sanM4N so rows Pier 11104 n1 r11• ok, of rwMe Pre wr •'ewe r.w O.f•r• ' ernO"Iw PMOL J QT SURVEY CERTIFICATION J EOEND 1 Pane/ do'" d,O, I here Osny.e ,Pr MOI Mrs em". "d 4•arle•d 0 arans or Alumirnun C4Wsd wo aaaool recovered a . «roof IP, kraft ."m oft-rw..n+...lna4 IN- Prop- 0 Iron plan OnOw rotor rewvend. lot, Par•a•edowr wrleow«weer'" se 141•.10 swserlr Ped tower O ast M,/Stock reaaVared as lowly vs wwlewt prow" Vfw M«Mac1" I%s►wntsas • S/B sz a"bar Sol "is survey IA ar••1ua we Bret alw• Me a• wdeero, et11111 IMP, of ofw •1,41. , R,�E UNE tAPPROX. LOC47-10A 1 ,e••eoPe• °, P•Is w•rwTr we.Mw Ydiwa•d woes. Scale / rre� r DateO9 _O Proparp4 !yt R. L BUTTON ° ©�� fi07/P79-62G0 aysr ICe/A�wQ. i,.�, �a�vo�oeami Ret 16,30 Fe. No. 14-00 Property of; Municipality of Anchorage e'..•r ''y'. • "` 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 Arsenic Advisory Certificate of On -Site Systems Approval # 100013 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 4 of Calais Subdivision. This inspection revealed an arsenic concentration of 17.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /oF nsitg) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 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. # C019 — -1 1. GENERAL INFORMATION Complete legal description l -o HAA# 1AQ9-2)01a1i cALAl S S11 -b Location (site address or directions) 3 o02 65-u f2. 1 -KA , SGP - AK Property owner pAg g'o('L Day phone �Gl _3o3 9 Mailing address Sod 2- EA4 (Ll=AKA ► �G�f ' �- �qSO 3 Lending agency (A- Day phone "1 Mailing address r-4 Agent rA a, Day phone A Address lel (A Unless otherwise requested, HAA will be held for pickup. C&'tL, Hp-, 1?SA t'k_ 2. NUMBER OF BEDROOMS: �- pyz p1cr✓ `Up 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1 /91) Front MOA#21 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 G,IASt::A wf4"T Address Engineer's signature A,--is2 SVCS• Phone 33%_(-"' 179 A',)c-N At- 99 0 4- 6. DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M aUTlr 9. "_gym aa► - !�N Ii . dw �`� ' •.,c�. ����� `'�� ill i • ey �. Gcrrtos� L� C •7253 (: � �! pROFESStONA„� bedrooms, with the following stipulations: Date T -12 —/,3 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.oT 4 gY— 3 , COrLA:/,& SID Parcel I.D. A. WELL DATA Well type SUVA I If A, B, or C, attach ADEC letter. ADEC water system number N LA Log present (Y/N) Date completed t4 A &KW''NN Driller Ur4Vt4 WN I !l Total depth f a 2 Cased to 4-0 + Casing height t� Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Nes FROM /WELL LOG t4 /4 Wires properly protected (Y/N) 9 -p.m AT INSPECTION rn .- ZI a^ o in N /� 1 0 • fes. 10.2-9. g.p.m. G � UNKNOW(J � c.+ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot N!rr8" ; On adjacent lots ; On adjacent lots N A Public sewer main X07 ! Public sewer manhole/cleanout l 36) Sewer service line '47 / Petroleum tank r4 A Absorption field on lot N PC- KfA, WATER SAMPLE 7ULTS: t� Coliform Nitrate to D ' C Other bacteria Date of sample: 341 ZCY3 Collected by: �A.2 '&-s& B. UPTIC/HOLDING TANK DATA NIA PUB(- t. S i=w Date in Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size Foundation cleanout (Y/N) SEPARATION DISTANCES FROM SEPTIC�ING T Well(s) on lot To property line S e water/drainage 72-026 (Rev. 7/91) Front n adjacent lots Absorption field Compartments Alarm tested (Y. Depression undation Water main CONTINUED ON BACK PAGE C. LIFT STATION Date ins d Size in gallons Vent (Y/N) "Pum High water alarm level Meets MOA electrical codes (Y/N " level at Pu j�rr! c Sew 621- - Manufacturer Manhole/Access (Y/N) Pump off" level at Cycles tested SEPARATION DLST-ANCE FROM LIFT STATION TO: of D. ABSORPTION FIELD DATA On adjacent lots Su NA p%39l_i Stu►e_(2, installed Length Width Total absorption Depression over field (Y/ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating System type Gravel thickness Total Cleanouts present (Y/N Date of a uacy test If yes, give date SEPARATION DISTANCE FROM ABSO TION FIEL O: Well on lot On adjacent lots Property line To building foundation To existing or abando system on lot >adjacentlots Cutbank Water main/ser ' lineer Driveway, parking/vehicle storage area n E. ENGINEER'S CERTIFICATION i certify that I have checked, verified, or bedrooms to all MOA and HAA guidelines in effect on the date of this inspection. Signature I Engineer's Na/&4Y- Date �G'Co PROFESSO�� HAA Fee $ /7 D ` y(] Waiver Fee: $ Date of Payment el ` 2 Date of Payment Receipt Number S� �21d) Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. v LABORATORY 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Chemlab Ref.# :93.1154-1 REPORT of ANALYSIS Client Sample ID :KITCHEN TAP L4 B3 CALAIS S/D Matrix : WATER Client Name :AK WATER & WASTEWATER SERVICES Ordered By :JEFF GARNESS Project Name Project# PWSID :UA Sample ROUTINE SAMPLE COLLECTED BY: GARNESS. Remarks: Collected :03/21/93 4 13:30 hrs. Received :03/22/93 R 14:00 hrs. WORK Order :64244 Report Completed :03/25/93 Technical Director :STEPHEN C. EDE Released By : QC Allowable Extract Analysis Parameter Results Qual. Units Method Limits Date Date Init --------------------------------------------------------------------------------------------------------------------------- NITRATE-N 0.10 U mg/l EPA 353.2/300.0 10 03/23/93 LLH ....................................................................................................................................... See Special Instructions Above IIA - Unavailable See Sample Remarks Above NA - Not Analyzed U - Undetected, Reported value is the practical quantification limit. LT - Less Than D - Secondary dilution. GT - Greater Than AAwo INSGS Member of the SGS Group (Societ6 G6n6rale de Surveillance) Alaska Water 8c Wastewater Services "Preserving the Last Frontier" March 24, 1993 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services ©n --Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Health Authority Approval for Lot 4, Block 3, Calais Subdivision To whom it may concern: Comments regarding the subject HAA are as follows: 1. Well Adequacy: The well was tested for adequacy by pumping 8.77 gpm (average flow rate) for a total of 69 minutes (605 gallons). The static water elevation at the beginning of the test was 21 feet. After 33 minutes (238 gallons) the well was drawn down to 38 feet (a drop of 17 feet). An additional 367 gallons was pumped out of the well in the following 36 minutes during which time the water level remained constant, indicating the well was recovering as fast as water was being pumped out (10.2 GPM). Based upon this information the well was deemed to be adequate for a four bedroom house (600 GPD). 2. No Well Log: The log for the subject well does not exist, consequently, the depth of the casing is unknown. During my site visit I did not hear any water trickling into the well under static conditions. This observation will typically detect any water migrating through perforated casing above the static water level, assuming water is present. In addition, during the adequacy test, I shined a light down the well to visually observe the casing and was able to see casing as far as the light would travel (38 feet). I was unable to draw the well down below 38 feet during the test, consequently, I was unable to verify if it was cased to 40 feet. Quadra Engineering performed an adequacy test on the well in 1985 and determined that the well was cased to 43+ feet. Quadra's report is on file at DHHS. Based upon this information, it appears that the well is cased to at least 40 feet; however, placing a camera down well would be the only way to provide positive verification. Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504 3. The Separation Distance from the Well to Public Sewer Line: The well is located 67 feet from the public sewer line which runs parallel to the west property line. According to the homeowner, the well was installed in 1962, therefore, it was constructed in compliance with the regulations at that time (SO foot separation). If you have any question, please call me a 337--6179. Sincerely, Jef A.��c'rness, P.E., M.S. Own consultant JAG/jag Bal 12.WPS 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 _U2.185 --- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 Block 3 Calais Subdivision Section 30 T13N RN Location (address or directions) _3002 Eureka _ _ -- (b) Applicant Name &odger Ball -- Telephone: Home 562-7411 Business Applicant Address _-3002 Eureka -- (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderX3 ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution First National/AHFC _ Telephone Address S. Center Branch (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Please Call for pick up__56 2L— Z-4-1 �1_ 2. TYPE OF RESIDENCE Single -Family EX Multi -Family ❑ Other Number of Bedrooms (4) Epir 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. i` 4. SEWAGE DISPOSAL Onsite ❑ Public)M Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 -025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDli—a INSPECTIONS, TESTS, FILE SEARCH, D. . A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigatic,n of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functioral and adequate for the number of bedrooms and type of structure indicated he, en. I further verify that beaed on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the cn-site water suppry and,'or wastewater disposal system is in compliance with all Municipal and State cotes, orc'nances, and regulat.or.s in effect on the date of this inspection. Name of Firm ___Quadra Engineering _ Telephone 276-3770 _ Address 401 E. Fireweed Lane Date 6. DHEP APPROVAL Approved for 1A1 Fn„r__. bedrooms Approved Disappr Terms of Conditional Approval Conaffional CAUTION Engineer's Seal Retyped, Engineers seal appears on orginal in file at DHHS at 825 L Street. — Date 8/12184 The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 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 (11/84) 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 R 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) f 4 Location (address or directions) (b) Applicant Name Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owneriouilder El ; Buyer 0 ; Other ❑ (explain); t_ (d) Lending Institution .` Telephone Address �• ��J�- —/� ;� (e) Real Estate Company and Agent "V Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single -Family Q Multi -Family ❑ Number of Bedrooms Other 3. WATER SUPPLY Individual Well 0 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWA,iE DISP(.^1L Onsite ❑ ublic `7 Community ❑ Holding Tank ❑ l "ote: If community well system, must have written confirmation from th State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health 4utho�ity Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate ' ft rhe 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 Q UQ DRA E616/NtEk-loy6 Telephone %(i - 3 '770 Address 40/ F�rIE WEED LAN Date 8�2�ag 5 1.1 �G OF At Vie® �j l oe hMic--•^••J-�t � E. Anderson LPJ ••• 4381- E r AROFESSVSA,�A r, s' DHEP APPROV L Approved for bedrooms by _ Approved L--�Di%p iroved Terms of Conditional Approval CAUTION onal Engineer's Seal Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 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 (11/84) r F MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) �A+UG iib CHECKLIST -FEBRUARY 1984 264-4720 R E C EI VE O Legal Description: !DT 'lr ,$Leen 3 '04L.415 .SURD A. WELL DATA Well Classification I��/��T,�-S/�M If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth /GS' Cased to t Depth of Grouting XostE Static Water Level 4e' 7" Pump Set At 7fr Casing Height Above Ground �2� Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) X Depression Around Wellhead (Y/N) Al Separation Distances from Well: To Septic/Holding Tank on Lot Gy8L1C SEAVA Wr6M ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots .Y1A To Nearest Public Sewer Line 47' To Nearest Public Sewer Cleanout/Manhole �To Nearest Sewer Service Line on Lot t7 Water Sample Collected by iQL9N '44"64 - ©dAIDR,+ ; Date�1� Water Sample Test Results SATISJAcMAY Comments W -Ge- AS CAA-46LR OF IrJEgr1A16 ,4'E4V&*heID 00Ae -#-VA, CAV,, Ilf ,DfjlTyil DE'T,E,[Iwi�yED w.r,V ,h�,tlolt. u1EL1 to s ,I�! ,l�7'r•MN�i FoR 4ft@f6MWX ~7 XA&ee'# &A0Wr n,vsa-,��A,+L.AQtEf'o.r r.+��s�•Psos.�ry *,Atsr*LLSA W 146& B. SEPTIC/HOLDING TANK DATA SfA1,6e SySTE/4 Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size Air -tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA S, k,/e�e Soils Rating in Absorption Strata Date Installed 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 To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness — Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) D. LIFT STATION 4vvdZ1C SE,W6/1 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent (Y/N) 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 r m� t[ - ( �s4'GLy�� c--� Date Company ' ydk r,,P IW' l tAIOMMI MOA No. Sr l �� Receipt No. 3LI O .aL,� Jr �[��•N••w•O�•• Date of Payment $ ` a'�� Ike'.• Amount: $ S� (� * ZAQ y-'�� %Engineer's Seal Page 2 of 2 72-026 (11/84) r 001 E. �.r 4361- E �;� PAOFfSS` 10- +t DlPARTM "O M AND ENVIRONMENr PROTECTION 825 L St reet , Anchuragc-, Al +ska MY 279-2511, c!xt. '4 Gate ReceivEa: _ #1: Time R2: 'fimu !3: Time Date ! r� Dat __ _— Date Snr.t Sns1�- -- tnsp RF.1!1EST FOR A?PkOVAL OF INDIVIDUAL i:WYV .\Ni} WA"flR FACILITICS ro 1. Lending i..stitution Request: first National Bank of AncbOrage Mailing Address: post office Box 4-2090 99509 Phone: 274 -ISI* 2. property Owner: John D. Ball Phonc: 277 -920 - mailing Address: 3001 RIMMstreet 99503 3. Legal Description: Lot 4 slook 3 Calais Subdivision 4: Single Family Residencet (30 !lumber of Bedrooms: 2 Multiple Family Residence: (y Number of Bedrooms: *' S. Well System: Individual Well kA Community/Public System ( ) Permit I Depth of Well Well Log �w Construction Bacterial Analysis! t 4. 6. Sewage Disposal Systemt On-site System ( ) Public Dtd-ity Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rata Material Distances: Well to Septic Tank to Absorption Ara& • to Sewer Line _ **&rest Lot line to *&&rest Lot Line , : V, T T,."qe TWO of Health at Fnvironrnenr,-I pL-q,jes.t fui Approval of fridi"'I, Wat Legal Ucticription: Lot 4 Block 3 Calais Subdivision ComcnLs: Affidavit Attached: Lettcr Attached: Aged Date: WtY Is, 1977 Dismog owed$ Date: prstaiMit Worksheet �t401 E. FIREWEED LANE ANCHORAGE, ALASKA 99503-2197 (907) 276-3770 130 27' ffaUS� v/7" q4I EL JOB /91-1016- G L.jl� -ra SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE 401 E. FIREWEED LANE ANCHORAGE, ALASKA 99503-2197 (907) 276-3770 a joB4a?:� 'I` AX .3 (i/Ghs SM -49,0 - SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE S6' 42' 5/' a der w e l oneovoeral o6e, //:57 75` ' L �( ELL LOGS i LUE6ERRY I W. No RTMERIN LIGHTS j 1 TI _O 1270 10 7 04 .O I 1 206 /1 so 21 11 Z804 1 74 3.0 1 /t 201 I 1 z 2 2 7 1-1 1p 20Dl 021 71 /f1i FLIPFEKO 1 0 BEN N I 1 /O _ ,2005 710V n05 J K 1 I oY 31 ` s W , %q 61 UNC 2801 C` B 1 LDI 1 1 _yl m 3 I1 f ZOOS zo O zw ._1 6076 7 6_ 6017 t 7 O 1 2610 Is 2814 W Ul1._________ i W. BENSON BLV D• 1 _ 2402 -- f.REFTLAND 3001! .11571 N I I 23 •3 _ /O -04 GOLOEN J '. I 4o34 y 2412 II I ':f 2106 f - H1i7x c1.u! �140� 1 - �„� P101 21 i3 1L -o ' 10 2411 /f 1Y2.1 2404 12441 S A Of 1 t 7- Hilt 7 -12 /7 I WO T CALAS A I 1 Yo1 I W IS m W. 30 AVE. � p � ALASKA •� O V 20010 ,29opp 5 C/ 1 (111 1 yl 50 39 3L 3.1 33 32 31 30 3001 3000 7 JL 30013 2412LG 0 3000 1 19 `ly 15 1 46 f 50 41 553 54 55 3g9d^ -os 3004 3 IP 0. I SOUTH PARK -W x007 gRCTTic BLVD. I 19 11 L 61 •3 12 7 40 ;1 '! 57 51 N •� 3006 N. 1 `0 1 71 T2 7 71 73 TL -4 80 1 82 502 30040 4q 301 301 / I W.31 AVE. I I 3100 3101.5 3100Sto13 131 3' YUKO K' I ARCTIC CALA15 3101 = 0 _ 1101 E 1 OHV N W 1 > 77S - 41 -W O •O I I •02 -03 loz Q z1 ami BEN 50N I I APT-. _07 3 $UPPLYI 3111 r�-ao I I -of 31e4 W PARK I -a -06 Q / 1-10 3150 1 31110 Z 731,11 -07 t 1 -o6 -070 1 V _ W. 32 AVE. m ao v v 702O 3z011 3201 320 310 32013301 ; 1 W 1T 1 910 z0 M1nxuN = • r E Q/ s 1 7 J ABtI ALA15 BLDG. Z I 1 1, „ V i „11111 A I I111� OJ = Y 3211! -1 i 13107 r 32501 - _ airs W s2�b�� 1%0� 3ZO1 C ST F I+ 1-1 It IA 1 I ZS5r�111 �,Ir11w x;17 3151 •� w 3_301 1,1 1 32* 3311 N W 3 1'Z`M 3950 w. 33 AV E MT. VERNON = _ 6 510 o I I 14A - - COMMONS O 1 6 tYflwafl i 61 3165 CON Dos 3AM 3z1 3301 5302 3334. - u I CALAIS BLDG.II 7i 3 4 IS 23341 Z' 1305 j 3301 G ST. I 95.44.4• W I \ /2_02 3 11 I 1 / M 11111 — �, -24 -232 ESOR1:; I I ., Il w 0� 3w 3364 1121 of 1355 I 3390 I 1 401' � V W. 34 AVE I I O POLAR_ 3.401 •<400 /1 1 X354 j w APTS. w i_ LA# -A IJ W 200 DOVER 100 33 m 6 s + zo ARMs_ o I ENTER I I � M M � 3.4OS 2 3aY6 — 71 I I M55 n 3500 / / I FIRST NATIONAL DANK I 1 n O EI De TZ , Z MID' Z 3 K 5OUT4 CENTCR gAANCA I Z LYMPIc CEM LF, i _ TOwN W j3 m O P� (opI W ,= OLOG. 0 SZ= FRONTt E.R AK. 31 20t W• 9v AVE. K v O r! ST. G14iDr r UN. A_ L`-- -------- ___________ 1 1 RINGER I GR. 1630 67 Spenard Area Reference Map—P7 82 ®� 84 83 Y 96 © COPYRIGHT 1985 JMR FORM NO 9-1904— AS A U.S. DEPT. OF THE INTERIOR iib h 1 bearborr� GEOLOGICAL SURVEY Recorded by WATER RESOURCES DIVISION GROUND WATER SITE INVENTORY SITE SCHEDULE If 0 S1Tl~ S/3/3-3- 36) 8,4613 - ' Date 4 Check One �Englrsh — Metric Units GENERAL SITE DATA 101 site Odom No RG Number R - 0 * Trikodge ion I T • I A D M V fi 19 Nd. dNH•. modify. —ified pe 2. C 1) ti 1 M P T * lllk l�ill 3- C L M.' * RoA 4- S .WM~. drain, atrdlhob. rpnnstor, snuhipfa, paniLls- d r, wwe flared allocated. uncheakod. location not, minimal wMl dials accurate dale S- • District • - * Stm 7 - D * or own) a . '- II,, If i /d i?, * deg to sec , Let -Long Lat}tuda 1 0- i"If" I !/ l * Accuracy 1 1 S T M� dej. _!.i. we file, 5 w. 10 sec. Yin ,2- ` B,D11 G Iv'* -.''-3- S F NI S,:IDI T iD, j 13Jf FIA63M/i 1, r t310tOt31310� 1/4 114 1/t uct,on, ii—iihm, •^N. m.,.d t Loon_ L L. �lTrAke r::;. / :..die _j. : Scale 1 5 • rY --Method i v Altitude 1 6= 1 I �t �1 !_ I I of MeawremeM 17- A L M rF Crary i 8- ammeter. le•el, map Hydrologic r S�n 19 • D C E F H K L 0 P S T U V gy * I 20 =/ D O 1/li /; DCI IVs O V ( g - Unit IOW depression. ss—sm. dunes, flat. hilltop. sink. swamp, offshore, pediment, hillside, brra.e, indlil.une. o[I Y. upland • channel Rat drew L: Datjof First /_ #1—T CoriEtrucuon/ 21 D '_ � �/ J '7 f7 � o� 1p 1 2 3- A D E G H 0 M P R S T U W X 2 d n' W IU I s 17 'Corgplation nth der I Year II rmo site Mdd•. drain, r ea- wiam e, Mat, oOserY- mrm, on or, reelssree, repress, —I...used. with- waNe, deflreY ed Ur 1... � ly I!4 �� thermal rssMr .tion. Mf drawal, Y w iv>dd 24- A B C O E F H I M N P R S T U V 2 • Q = I`1Wa'er aril condi. ba ttline, omni—I.I. d.water, Power. Ina, demestrc, rrrieation, m•diciMl, mduatrial, puhlr<, r•cre•Iron, ftoeY, institution. •nosed, decal, other nrpply �-----t--t Secondary 2 5 - * Tertute Use 2 6 . # Depth of 2 7 /) /_ Depth of Source o/ �� _' Water Use of Water Hole I l l il t 1 Well 1 7 1fJ ! t I I l'� 1 1 Depth DauJ 2 s Water Level 3 0 = _. 1- 1� 10-L • Date Measured 3 1 - r $ourtxO •nth day, r••, Method of Measurement F 3 4 -� A C E G H L M �� S T V 2 '! f •mhm., calibrated, estimated, praesure, tilibral•d, geophysical, m•rontow, reported, nMl, d.ctirc, eartual•d, othw aulrrw eye p•soue gap logs wp lope Neclru: lap � 37 D F * G M 0 P R S T V X 2 Site Status_ dry, fl—tea, nes,by,neerbY. obstruction. pumping. recwrtly. ruby. m orbY. tore,. sudac. e.tw other fk_.N ra ,IV pumped pumping lepnrty wbnonce .Rests fbwu,g pumped Source of C 3 6 = • 3 5 • * Measuring' 266= # Measuring 267= Gaohydrolog,c Dau Pump Used Point Point Date np mwnth day rear OWNER IDE IFI 1 N (1) Deft of i= R-158 1 * 0 ls9 0/,zo/ add, desate, modify month day year 1 6 N -*1 6 2= L �� N E Middle 1 6 3 ---?Ts� Name: Lart first l i 7 i i I Input i i OTHER SITE IDENTIFICATION NUMBERS (11 ,44 76 /=AI L�fli� R- 1 8 9 * rT • A� D M Iderlt 1 9 0 * Assigner 1 9 1- P '* ..it delete. m.ddv i NeG Same R 8 Maul 1 9 0# O * Assigner 1 9 1• � iR i�l i 1 --1 + NO UNCNS L s!t /9/ = G 0 A1,17 1A15 4) A SITE VISIT DATA (1) R • / 8 8 * T - A O M i Date o1 187# / / * Narne of 1 6 8 - -T ° e Visit Person �— — -� i a..1�.�___ �..1 lit .dd drtete mod,ly month day year, FIELD WATER QUALITY MEASUREMENTS f11 R. 192 * To A D M * Ont. 193 / / * G , o -195 N a oqi Lhlt I I I I 1 t add delete. moddv omh ear rail. N..v c„d Same tee jj 0I 0 0t 1I 0 * tg7 . daR thio 195 Tonlpersture t Degrees C Corrduetance 106 #1 0. 0, u Mhos FOOTNOTES 1'Sounce of D+ter Codes S D Q Other ISTORETI I ills # Pantttebr Other (STORET) Paramour A R L G 2 Mhr• eoa. ornw Loa. Orotops,,.,h:, repo,,.d Value 197 •� • Value 197 - k WELL CONSTRUCTION DATA 111 D �• Source o1 C' O+t+ of Cisnttraction 6 D - �a . s! l ComL Dau 1 6 4 - �D' re T- D M # Entry Na 5911 # Cfrtlpletion month day veer , dd•R, mofisr Name -_ 6 3R L! It CuntractolDriller T- R T V W. I s ZMethod D H of 6 5= A B ILTr% J __P 0-9. ars. en. d�osn.r Construction __ — bored, doe. n,n�a�,i�._ c� "—d, r <,,.. crP.- r �y � eol.rY v.� a,h -, •ry or a,rgrM tool r.,a r _ i •_-_ __ --_-T TYPr o1�67' 8 C G Z •' Finish 66-I C F•O1 G H V Set i- ._ � .m•r,s em•r benlo nnr. clan. c �_. __ yrar•Iw gravel, hoiirontal, Den. prrin..leA a„e•n, Porous. ycr.en gallery. end or ,inttrd crew vnf _ •�rd poen r, walled. oP.n. oth.r1 • bol• ------- -- —7 quu I Number of Hours r Bottom of T e,. Method of r 6 9= A B C J N P S Z I k I in Development 7--- 6�_ Seal I 8 _--�-_�. Development ; ._ ' an I,Is, onl.d,compi •,+•n. P^P a„ laud. r.o ne. ome., wrq.d, usher PumP Special Treatment --- 71 C D E F H = M _ During Development rnem Dula, Err a•. •=P�oarr o. e•noculms. nr nr or..rsm.... mwi,ao�ol, emv DIMENSIONS OF THE HOLE CONSTRUCTED 121 M # construction69 # # -72 # T - A D Entry No ad . dN•u, modify Top of Halt Segment Below LSO 0„Isom of Hole Scament below LSD - Diameter of Hol, S"gmrnt t .l • # 73 i1 • 174- 74 = I - ► 7 5 ='. New Card for Each Hole Segment ; 7 3 # • # Same R, T & Field 5 9 I # 74 _ 73# •, 77=. 75 - J* E73 # •, Irl _ CASING SCHEDULE 12! Const—urn59 # # [* EE # T- A D M Entry N,- New Card for Each Casmg With Same _ --- — --- R. T & Firld 5 9 --- "-- ”- - • , deter•, modify Bottnm n1 Casm9 Sraltnent B,law LSD Diameter of Caslnp Segmens Mase nal 5 Thickness of Cesing Using T Top of Casing Segment Below LSD "j �78-• 8-1_ .�VJ 77# I s l %�•1 �_. Irl 11Y"t 79= t 80=• ---� 78 • 79' * 80- • __ __ r81 i 'k 77# l I• l� �• 80= y,• - 77# I l I I•t� OPENINGS SCHEDULE 12! _— # Comlrocvon 59 # A D M No k T• �B ETo100"n S --Cin With New Card for Each Open Sectio an Sam" R. T d Fmld 5 9 - w-gt Entry and n.:.0 madly 'ngs D.nal (Oci—nq, Dmal (OP—ngr Data) # B 3 # # [.3 # # 1 • i Top of Section Below LSD 183 # t S �. 8 4 i Bottom of Section Below LSD 8 4 = k Type of Openirgs © 8 5 - # 86 = * Type of Mal—al 7 8 6= i k. a(, 1 87- 87 Diameter of OP- SecbOn 8 7 88• •- _ -_- Width of Opening 86= ski L—ath of Opening L_ FOOT NOTES. 1 Source of Data Codes > i ,..c, •.•,•, .....I Codes_-- M P R S T U W Z - L G 7 F C G 1 l•... •...rna. w u nI.PVC. reyorbnq, e,• .r uwn other qur't n+ ,., �.. a..•�,•q.•, o. "' .r Pnrr ne iron non mein pi.sr¢ aro n..l aa•ncr • 11 Pr .,I Metrr,nl Cod -for Open Seevons 6 TVPe of Open•.-, C, ,..s - _- T Z _ P R S T P, \ - 6 C G 1 --a M P R S r F L .. „ 1. wroogn r. b�a,s o., conn r �mr•, P•_ ,.r a. «.,. Ilea, s,lr. , nr,. nrnnr. nnn ..nn Tesal n,e'+s.c brei snusr-�+ o. slostee ..Dune mrae— Penns PRODUCTION DATA (t) 19- 134 14 * 1 T' D M. En,,,, 147# * DateJ_/ ?K -b6' *1 nolo- ,wntpad add. delete. teedaly month _,y Vaar Dileharye. ISO- * Source of Dotal Method of -- ----- --- _-- _--_--- --_- -♦�� 152= 8 C E F M O P T U V W Z i] Measurement — ba.le..es •nt, lrmaled. flume, totahny, orifice, pilot -tub•. reported, lraleclorY. ran tori, repo matn<, we, of her Curr meter meter meter *I � * 155= i 272= I •* Production 15 3 - ?-- -- ll_ Suuc _ _ _ - -_ �J� Source 1 Specific Level Level L154= _ _1.1 of Data __� CapacitYl`__.-_:-1 Method of r-- - - " - — — Measurement 11 5 6= A C E G H L M S T V 2 �i Pumping Period 1 5 7• t e 1 ' aal-ne olrbraled,wlimated. Paewte, oldraled, 0-01 eiul, meromww, rgonad, neel,electrit,-1,Wated, otltw .0—WePaaaura Pee tefa tape tape «echi<tape LIFT DATA Ol r R-42 i T- A ID M i Typo Lift of 43# A B C J P R S T U 2 i Entry 254kI '* No aac peI•n. mod. y oil, btreku, eentrifepl, jet, pnton, rotary, aubrnM•ibla, turbine• unknown, other Pump Intake i 4 T- -- - Type of Power G M L N W Z 1 J Setting L - _ d.erel, electric, easohne, hand. LP gas, nal urel, wrndmdl, other en ) ill 1 Date 38 =_ Horsepower moon dey MAJOR PUMP DATA (2) TypeolManufacturer ear 115# * End Year 1 1 6= t I IE ---- -1 T- A D actl- efts e, 1T*j Ljh 4 3# mod•tY i Lift Entry No 254 J: f of Pump c -- - Serial No 4 9 =jI -- Pump - - * Name of Power 5 0 Frecu nncy -- -: * ! 1 1 t I* j _ - 257 = * of 1.L�___ __ ._�_l_L.�_i_ I Company of C'i:!!.•chon i _._ . _ ._.j Power Company 5----�, j Analysts - Power f--�-- —ry Pump 153 _-..�*_ Account No L. _ _._ _..�. f_ I I I ��� Meier No �5 _1_ I I I I I 1 I _.i_� Rating L_ Person or Company Who 54 = * 255 ' * Rated Pump 268. * - MalntainsthePump -- ------ 1 _L__J Additional Lift I Capacity STANDBY POWER DATA ,21 ISee LIFT DATA for codes of fields 43 and 56 below) F— Lift R-55 i To A D M # Type of 43# # Typer of 157=I * Emry 254p� Lift Power Horsepower____.1._ i l_�L-ice No ell moll. y AVAILABLE LOG DATA t1 R-198 * T- A D M i FNew Card for Each Log Type add, delete. R 8 Tta. modify -. ------ Type of Begin 2 D 0 - TT _-__rte. End zt D _ _ _o— -* Source of F2-02 202 Log© 199# i Depth 'i. _t. _ Depth I -�7t.1.� t_� Dain _ _ l� 199# is 200= 1 _. t'j * j 211- _..I I I !!.�202' 199# i 200=-L * 201- �L�`_ * 202= 1* 189# i ._200= * j 201= 202- tel 1'.ATFR OUALITV DATA COL,ECTION (1) Ter A D M i --[-Begin ear 115# * End Year 1 1 6= t I IE Source Agency 3 Frequency of Colleotmn Cud,, add. delefa, madiiy A c -- - L G— Z .. A_- 6 C D F A o S Frecu nncy -- -: * ! 1 1 t I* j _ - 257 = * Type of 1 2 0= 4 1u9,. Geo oq•t ,other 'a ..♦ Li moot Al r. eonl�nun.,. da.;., to ,ntr.m ntrnt, montnlr. orw •, ouar se we. . ,r.nr • of C'i:!!.•chon i _._ . _ ._.j Network Site j Analysts - mon h:r o r annual a••n„al �. A7I k L F V1 L DATA COLL: -11,'J (1I R=121 i T= A D M�Boon 122# i End - IT7' 123=1 Source T 124 Yebr year. I l i Agency laleri_q, m,[ral^<. n•ut,.•- r firer. pn,•,. ,...., add, delete, modify conduct T E. le 258 = ^ a Tr t~ d Chi,.. t-: Anal Vsus Codes o' Cuheel a>n 3 L_1 _ Network Site - �- 7,AiFI+PU7.1VACE iITHUK.-AL OATACOLLECTiOr. Ili .. 8 C D E -- F G H ! K L _ i T- End 129= Sour- r 130 a R•127 A D M i° 128 i Year # Vear L� Agenevi ! add• dsute. modify T Frequency 1 3 1 e 3 -- - -- 259 = * Method of I— 1 3 3 C ----- F M U Z 1 o! Collect ron _ Network Site calculated. es matrtl. me feed un\nu»n, other OTHER DATA AVAILAELE R -180i T- A D M E Type f 181# i L«1182= C D 2^*_ Formate' 261 = F r.' P Z add. delete. modify m•n d"v,c, of n.. tdn, m c ane. puhl•.n.n nmr• New Gird Same R P. T Type of 1 81 # - 4 C_ Z r 261 -� F M Z P Dau Loo -- - -_ - _ Format F('.Ol %. )TES -, _ of C.!a C-'-, 3 Frequency of Colleotmn Cud,, S D A c -- - L G— Z .. A_- 6 C D F A o S �. - . - _..,e eu_ t 1u9,. Geo oq•t ,other 'a ..♦ Li moot Al r. eonl�nun.,. da.;., to ,ntr.m ntrnt, montnlr. orw •, ouar se we. . ,r.nr • r•..n ted. mon h:r o r annual a••n„al - B C D E F G H 1 J K L r•+ N D e u fl.. d. ar='•_s, a9net,c. �nd::c„nn. pamm�. d-pmele•, laleri_q, m,[ral^<. n•ut,.•- r firer. pn,•,. ,...., conduct T V Z 4 Tr t~ d Chi,.. t-: Anal Vsus Codes r^^. ••!�cl. .. 8 C D E -- F G H ! K L _ c [.. . yca twri t.pn nu,rn• . cnem:oi «emr.tt tan ., v nein - :.. .., n -d-, •.•- esD est C.4J or.1 C L'• _ .• s GEONYDROLOGIC UNIT DESCRIPTIONS 111 R • 9 0 • T- JW D M I.IjDepth9 1 Q t Depth to 92- r_. • to Top . I IU 10 i. i i Bottom S # add. /d.ltn. Unit 93. 1.1-E/ A!` /t� 11 �Y 96 7 �L • LiMdopic Iden ilia, r Lit' 1 1 Modilier 7 A rJ c R1 IL- AQUIFER L AQUIFER DATA (2) T= A D M# �►aroyl � I I 1 lJnit Entry Noo 266 # � � # add. del.te. modify Do" I 115 # / / # Water Laval 126 - 1 I I I • i -TR % Water Contributed 132 - • meets day yar GEONYDROLOGIC UNIT DESCRIPTIONS (1) R-98 • T= A O M # E 256# # M 91- I# awl. 92- �# t ,s• add, deleta, mod -IV .Unit p 93- 1i O # I - - Litholc 96- �5 �.r., # 97- JC Iddntifidr M1 Lithdogy. _.� _! .— Modifierol i --- _- 3ay�p� AQUIFER DATA (21 T - D M # Geohydrdo9pc 258 # #. _ _ Unit Entry No add. d.l.ta, mod+ry Q—` Date # r�-L..D/'C' t / �, ` (a I # Water Level 1� ✓ %Water # Contributed maean day ver PERTINENT REMARKS R=183 # FT - A # 185- I I �# add -r New Card Same RaT 185- I I- 1.1 I I 1 I i I I I I I t i I i I I I I 1 - I I I NOTES: t C, S. OOCERNMENT PRINTING OFFH'E : 1-- o - 313-137 WRD exp. (GW) ^ April 1966 U. S. DEPT, OF THE INTERIOR Well No._ WELL SCHEDULE GEOLOGICAL SURVEY Ik �GD WATER RESOURCES DIVISION AAASTER CARD Source VR2 Record by L/�/7/�{�O,v y of data L O Date_YA 6/ If Map State 6 ° (oorntoown) zNelloeAGI ] s ' / ' % �' 2- N ��� , �' , ? / Sequential Latitude: r S Longitude: 111 / , 7 :.� i � � number: g 7 min ♦ sec n u egrees ,s min sec is ,y Lat-long N E _ accuracy• T. / 3 S, R 3 y, Sec to LocalOther B 6 M p O •� • rel l number: 4 number: Local use•O� 6 ' ' ' n •^ �/ Owner ♦oL , i �s� - , si or nam35 e• ` YTS �r Owner or name: , iA, �� 1 I'C— �r.. �' ' ' Address:,7D0J ,,i,'� lit�l7 ss s ss (c) (F) (M) (N) (P) (s) (W) �07'S0z I(leG7/f Ownership: County, Fed Gov't, City, Corp or Co Priva[ State Agency, Water Dist 67 (A) (B) (C) (D) (E) (F) Bi ' ) (H) (N) (P) (R) Use of Air cond, Bottling, Cow, Dewater, Power, Fire Dom rr, Med, Ind, P S, Rec, water: (S) (T) (U) M (W) (x) (Y) W Stock, Instit, Unused, Repressure, Recharge, Desal-P S, Desal-other, Other bs�/ Use of (A) (D) (C) (H) (0) (P) (R) (T) (U) , (W) (x) (H) eo6912well: Anode, Drain, Seismic, Heat Res, Obs, Oil -gas, Recharge, Test, Unuse Withdr Waste, Destroyed DATA AVAILABLE: Well data ❑ Freq. W/L meas.: D Field aquifer char. 77❑ 70 11 Hyd. lab. data: Qual. water data; type: Freq. sampling: Aperture cards: Log data: WEL L-DESCR IP TION CARD Yea Pumpage inventory: no,period- 75 ep riod; 7s 73❑ 7`a — 761:1 ye 77� SAME AS ON MASTER CARD // , , Mea Depth well �(O ft xbF rear 1+ ao xa accuracy Casing Depth cased: � � , �$ (first perf.) ft type: Diam. in xa (C) (FL (G) (H) 02ndP) (S) ST) (k1) (K) (E`) Finish: Porous grave W. gravell w. horiz. Pelf., screen, s pt., shored, pen dole, x9 30 (� • concrete, (perf.) , (screen) gallery L J 91 other— Method (A) (B) =(C) (D) (H) (J) (P) (R) (T) (V) (W) (�) Drilled: air bore cable dug, hyd jetted, air reverse trenching, driven, drive rot, rot., percussion, rotary, wash, ot— er a7 Date / Drilled: V Pump intake setting: ft as is ss as Driller: illi • DO%T —,V _ /f1�/C/j�D21966' address Liffe (L) (A) (B) (C) (J) (M) (N) (P) (R) (S) (T) (g) Deep t e air, bucket, cent, et, multiple, multipple, none, piston, rot, submer Curb, other �� j (cent.) (turb.) P R, Shallow 39 Power net LP Trans. or bo (type): diesel, elec, gas, gasoline, hand, gas, wind; H.P. meter no. above Descrip. MP 'P ft below LSD . Alt. MP Accuracy: .7a Alt. LSD: source Water above bx above, 63 O � s7 D Level ft below MP; Ft below LSD Accuracy: Date be $1 Method mean• p 6�sa-iss Yield: J gpm determined n ]0 60 , Pumping ' Drawdown: ft 6 ' Accuracy: period hra 6 Llae QUALITY OF 6• bs WATER DATA: Iron Sulfate F7Chloride Hard. n Ppm 6• Ppm 70 Date 71 ppm Sp. Conduct K x 1060 Temp. 'F sampled 73 7• 76 77 li Taste, color, etc. ft. well No. Latitude -longitude v / S d ■ s d Is ■ HV DROGEOLOGIC CARD Physiographic SAMS AS ON MASTER province: —F— Section: I F-1Iraina e 1D I I O '� Subbasin, as n :a ss �e as _ (D) (C) (g) (P) (p) (g) (L) Topo of depression, strea■ channel. dunes, flat, hilltop, sink, svamp, yell site: (0) (P) (S) (T) (11) (v) 27❑ offshore, pediment, hillside, terrace, undulating, valley flat MAJOR I AQUIFER: AQUIFER ser es aquifer,formation, orat on, group �-3F- D system Aquifer Thickness: ft Lithology:' Length of 3. I�TT1 ptn I � © well open to: w to ft L at I�oJl t� of:: ft as 37 T[INOR ! UIFER;system series ` " aqui er, ormAquifergroup •s 47 , 0 A Thickness: ft Lithology: Origin: so Length of Depth to � I vell open to: ft top of: ft s7 s• s l sa . Intervals Screened: Depth to , LOO #A consolidated rock- ft ' �a Source of data: Depth to basement- ft Source of data: Surficial t Infiltration 720 material: 7oy7, J characteristics: Coefficient oefficient Corage: � I Trans: gpd/ft 7aJ 7t 7_;S Coefficient Perm- Z gpd/ft ; Spec cap: gpm/ft; Number of geologic cards: 7r s�C+ $6' �4g weAt: tvc. :r cti,,pf r v GPO 857-700 E z 0 FORM NO 9-1904— A SIT, ^ SB /3-3 — 3U GS C Ii •� U S DEPT. OF THE INTERIOR I n ��`` GEOLOGICAL SURVEY Recorded by n jieAr Uor 11_- WATER RESOURCES DIVISION Dote GROUND WATER SITE INVENTORY SITE SCHEDULE I/ Check One _ English Metric Units GENERAL SITE DATA (0) site Idem No 3 RG Number R` 0 * Tr,l, T• A D M V 5 19 add. dalae, modify. verified Onto Ste -Type 2= C D H 1 M P T * Reliability 3= C tl L M * Re� 4= w k—, drain. wakhoa, rsernnetw, —how, pnd.ni'moi ."160 ti.id akacked. Ynahoak N, location .at, nimsmal rwll drh aeeureta data •�7� �] tty I Nu lett I S= I I I I I J taiteiet 6 ` P * SLM 7• * We Wetpwhl 8 9= ; �� , / =,3 , o • / v . 3..' * Lat-long S T M L•fitude Longitude Accuracy ',._._ if �. T_� Loved sac• 5•-.10 sac•�1 _ _ dal min wa d n I Local 1 2 = t p ,.I i� U.� Loc. Net1-3- li--,-TJiC �/ /S 7' T -3A��... YL'\`TTa� Number_._-___ J✓% %J1 L_1� l� I W G,� /} O �� ✓ j \ 1 1 1;4 1/4 1/4 a.etro n. tow nan,p, ange. arta Location Tr1.r'►•(1 �1 G 1, ' //^• f _ \+ Map 14=1 1�_�11.!1 LL�.1 111 =1_ I4 ';f/_ -t -Ci —1 :�1�� i L er Scale 1`T1ot�1 ��. I 1 �U {i�D T t Methol o1 1 A L ! ..I • 1, , ' j Altitude � 16 = • I I I � Musurement 1 7 Accuracy ' ai,mon, a.rl, map Iopo" - D C E nF H K L O P S T U V W * Hydrolog.c I 20 p �► .. _. ._- Setting ` ly.� -- UnitIOWDCII /I/I1),✓�DI�iVP`I i d.p.ss,on, m, dunrs, fat, li,io p, rink, swamp. ollan nr._ p.d,m.nt. h;ueida. I....... d.1—rig.Ii.,. upland [Hann., fat ora. :Date of Fust Use --� 1 i !Construction!! 2 1= 1 / l�l *) of 2 3- A D E G H 0 M P R S T U X Z * I JCompletion montn day Site ` ane., drain. gp seism A.. t, obs.r. min. ori or, er cha,q., r•P,ass, tot...tired, wuh wars., dovor.d _. thwmal ..s.,. at..., gas drawal, '^- I water [ 2 4= _A _ B C _ D _E F I M N P R S T. U y 2 '► n enc one ., bottlin q, comma. <ia 1, drw alar, power, fur, epm.sl,curigatlonmedurnalindusir.alre , , , , public, creation, stock, institution, unused, dotal, other aupplY y—' Secondary i 2 5-T Tenury Use 2 6 - a Depth of I`2 7 ' - -- -- -� Depth of 28 = �* Source ot�l 2 9 = h Water Use of Water Holr Well 1 Depth Data 130- ¢¢ • 31= �1 / / # (1133=1 T* Water Level �- �1.J.,it1.!1__t -- Date Mrnured '`��-1 Source , __ _ manrh dao Y.., Method of Measurement 34 A C E G H L M /� S T V Z n 4b obb,.,W vvi m ad Peawrl u anaied q.upnyr,ul. marorrtat.r, nportatl, nwl, .Leet,,[ sahbrat.d, othw aa1rM 9". Peru;. a.W lops Uq tap• Mact.s tape Site Status _ 37 = D F G H 0 P R S T V x Z _ d,r. lbwng. —rbY. .uby, ob,ouninn. wmp.�p rnr. „ by. roarby. fineq rerlacirv, , who, ibw,no nt1Y __d P,mp,ng r.c.mly wbstanc. .l leets fbw,rq pumped Source of(11 3 6 = Q * 35 • 1 Measuring 266 * Measuring 167= _ — _- • Geohydrologic Data Pump Used ` Point Point Date .. month day Yar MVNER IDENTIFI ATI f1) R=158 • T= O M • Dote of lisgo O // / I Ownership add. delete, modify path day ra.r Name: Last 16 ! T E !V 5 • m 1 6 2- j_T14; _ `i MldAle x 1 6 3= T Ts First ~I i i.- Imt,al i OTHER SITE IDENTIFICATION NUMBERS III tB Q.Z .iC %I = /�.J;r : '.Me R = 1 89 * td * T= A O k.,. 1 90 4 * Assigner 1 9 1 =.K.%<•�r add. d.i.t.. mod,is New Card Same & Idem 1 9 0 'Al Iig 9=1 -. .-- Assigner 196 ll int C e)/1 L ail /!I'. C (-/)F/;i = i. SITE VISIT DATA (11 Dote of R=186 * T= A D M *11874 * Name 188= I T_ -'•'' Visit Person ____ 1�. . I t acddelete, modilr -11% day year FIELD WATER QUALITY MEASUREMENTS I11 R=192 * r= I A D M * #1 Geohvdro 195 .1193 logic Unit i add, del—, mod,ly n day yea. RenriC,aLSa•"r 1964 0 0 0 1 0• ° Temperature Degrees C tg7. COriductanCe I 116 4 0 0 0t1 S* u MAtx 197 I I a f Other (STORET) tfi 4 • tg7 . s Parameter 1 1Value Other (STORET) 1196s:1 • Parameter Value FOOTNOTES Source of Data Cod -.- S D . A R t \i ,.p, :'."y e• .,� a.ner go.'t . o,nw a v + •. . , •. K _ S".—of t r//�� 7 Cons Dau � 64 r DATA Date of Conttruc 6 0. � 74 -T yrr WELL CONSTRUCTION 69 # � * Completion rnenth e•r ' pM * Entry No * L 7 8 L 77# ` - - --- add. s•rn•,.eeaitr T # ComvucGon 5B # p - g2 * T- A D .dd, dela•, mn"y M * Entrr No (Openings Data) } ", * Sectio^ 13e1ow LSD 83# # V W Name o1 I CuntnctorlDnller '_. J P R T ower 4„re^, e�' •' -- - --, C p H — e. tr• cb,n•. an �6 5 = A 8 Method of _ - — � eus. hvd” „la, Ltt.d.�y c° ," rDt f 1' C G 2# 1 Type o 7 •- B I J Con,uctlon --r. , bora, or auq•red < tool/� r .ou v yy x 6 2 I * I Seal �- 1 „enl°nnr. cl.v• <groul' other •m.nr rot•rY S T P d sc.. - ..r^� ns•sn, Pratewound --,w wnl P -- oYn.a F 0 H - scr•.n. . d vo1nc. r..u.a. °noi• —>ef— 66=�, hon ---1- vn. Fmsh C _ _ - _ - - e.rdr nY.e. von slo .a - -, - # Number o1 Houn 1 70 1 gr••� .•I . --- e•o.<n ya:urv. end P S 2 1 #� in Development � 1 . eoroust tw nod • P ---1 - -1 Method of 6 9 = ` C A B J n. nor+. N om.:, wrq.a, otb.r - —�# DevelopmentL- - Bottom of t68- , - <omv, ase I•tt.e, ar lt, b.d.d. i � pump y-, Seal---`— PumP - # i - T -- D _ m.w•s, e.no Speclai Treatment 7 1 C- ul•nt. nvdroY'.<t..urg. m•ch+nol. Den Durinq Development --- -ch„ n,cals, dry rcc. •"p DI h1ENSIONS OF THE HOLE CONSTRUCTED (2) Capnruction59 # R X72 * CT- D M * Entry 140 •aa. a•I•sa, modlfr Top Of 1,0f.3.1/^•nt Below LSD * 73# New Cd for Each Hole Segment 73 # Feld 59 ame SR. T & 7 3 # 73# Bottom of Hole Srqme^t below LSD_ 74'1 1-741;_. ♦ i_•i� � 74 -T add, dd•N, modHrm•nt Bottom o! Casing Segn""' 1(74 _ f*. 74= _ CASING SCHEDULE l21 Constructicn p -Ts * T' A D [� M * Entry No Below LSD add, dd•N, modHrm•nt Bottom o! Casing Segn""' Mt Blow LSD Top of Casing S.p^ T j(f * [7.8.1 ht p 77# w nod. nlner �Souree o1 Data Codes- G 7 * L 7 8 L 77# ` 77# _ L A R OPFNINGS SCHEDULE (21 ComvucGon 5B # p - g2 * T- A D .dd, dela•, mn"y M * Entrr No (Openings Data) 51 0 •r. olner 9nr'1 . I�ys. n :oast oln.. * Sectio^ 13e1ow LSD 83# # Top Of Section Below LSD', 84 A Bottom of © 85' Type of Openirtgr 6 TVP, n f Openings Coes __ \ ','atenal — TYPe 01 Dlamelr• of Open Seenon 187', .-_L_L�-1 - .. # WIAth n1 Opening 88= Length cf Ow""i 89 c -. 1 f.• . - -- Diameter Of Hole Seg men, 75 # 75= # 75 s 75=' C75 # Card for Each C -3 -ng VAth Same Rf9 _ T Fteld 59 '1 New I ment Crit,, Material 5 pometer of Casing Seg ,i 8 0 # 79 - — # 80_ sJ 7 # 80=_ rJ 79= 79= Th,ckness of Casing 81 81= 1 #, I,81 _. Ne. Card tot Each Open Secuen Wnh Same R, T and F Irld 5 9 N _. IOPr'nm?s Data) (OPenlne` Data) * 83# 83# 84=#. # 85` * 86= I.I 86= ' 87# 87 # 89= I i1 89= S Cnnng 4tan•n.11 G,d+n _ -- - R S 7 U SJ Z FOOT NOTES. ht p w nod. nlner �Souree o1 Data Codes- G 7 G C G PV"C n r. c« or. sr •.1. t.l•. cnald. a.el _ L A R br.<1 d .•t• y.lr' or,9nt < n< nrher, nal Pi a5l is •Inn• 51 0 •r. olner 9nr'1 . I�ys. n :oast oln.. n $eC1�nnS repo dr,Dll•r.d repdrir«I, 2 6 TVP, n f Openings Coes __ \ .. � B C Z G 1 !A oa', 1. ,tn.•, ......., vvr11` S T W e.+ c <rne. 9, w, «r .n• •1 pus r... F L h1 .p _R _ une, ..,n.e. ..t •� n.on.• non ..nn , d sc.. - ..r^� ns•sn, Pratewound --,w wnl P -- earl b.cuvr snu—d .slotted -—d PRODUCTION DATA (11 •R• 1134(1416*j M I ;nIryNo!147# 1/. 1 Data 8= /D/ /ra 'nof(ll flame. Punivid add. detester -.4.fy --h er vast • -77' Source of D,1�.l 151. DISChongo: F75 0 t) Method of E--0- Is Measurement F T U V b.-I.I, c-ent. all-Isid. 11 -it. -1.- p too ti.ibe. revolted, tr.laetory, ...tori, .0--..wai other en-, 'meLr mets ProT Specific 7- Le,ecirction FIS 3-:7 1 Static 1 54 urc LevelSo 55 * of Data Capacity 272 Method of Measurement 1 5 A1!17- j Pumping Period 8-1-, WAriatod. ref -rad, Weastur.. cailibtred, qwphvs. al. mit—ft. Isponed, u1j],nited, citlit, sammi': "" lop tap. "Pe electric I. - LIFT DATA (1) T- I A 1)Trp**1 7 3 Envy U 4 �� h # A 8 C J P R S T U �z No .dd.d.I.I., -0, are lit-tiliet, ritibitiati turbine, to dtto em other Pump IntakeF44.E---- -T*I, Power Tvpeofj4I - --- Setting 1 5 D H L NW z d. -I. •.- 9-1- hand, LP a... -1-1, .-d-11. .1h., $a, --T Date 38= . - - i46 I L-1 Horsepower I -.1h dis, MAJOR PUMP DATA (2) --T-1 Tyof Manufacturer F4 B - • 3# s T- I A D M Upe ft Lift Entry No 2544 *1 of Pump Serial No [4 9.1 Name of P..e,'---T of Pump ' = • L 1-=j Come 1 1 1 1 1 T Power Company P...' ' L52�[ Pump Account No M,t,, No I I Rating 5 3 1 a I I Person or Company Who. 54 Rated Pump 218= Maintains the Pump - --L- A-1— Additional Lift Capw.ty STANDBY POWER DATA (2) Mee LIFT DATA lot codes of fields 43 and 56 below) L Type of Type of 5 Lift Lift Potwar Horsepower Entry T- I A D M is add. .1 - 'e -.111 No AVAILABLE LOG DATA Ill T= (A) DM= New Card I�f E -h Log Type - S-" & T add. delete, modify Type of # • Begin End Source of 199Death:2 00- 2 0 1 i 7Q. Depth 202= Data 199# • F200=1 2 0 1 1021= - 0 21= 199# s i 200= 0 1 at 202= 199# 200-- 2 0 1 202= WATER QUALITY DATA COLLECTION 11) Begin I 15 # End 1 1 6 Source -71 To YearYear-- I Ag-cy T- A 0 M add, delete, modify Frequency 1� -- i I *C 257 a Type M 4 r- -2 of C.11ecl.. I EE Network S,,c An.fy— %',ATEA LFVEL DATA COLLECTION Ill T- I A D M Fs 8-n1 ynAr�123 Source 122# 1 1 -T-1 add, drilissis. modify Frequency ------- 7--1 oi Collect— 3 [ 1_2 5_T Network S.t L_ V.ATEF; PUMPAGE VJITHORAY.AL DATA COLLECTION (1) A D* Begin End -------- TYear Ylz9Ayr rtc, adda delete. modify -� - T-1 ----E N1 U F;"q -T3 *j C.1,01cin 3 Network S,, C OTHER DATA AVAILABLE ill T- I A D M Type of 261 F 1`11 P Z Date 1181#1 1 Loc' 182 C 0 Z F —► - add. delete. modify 10- P.hl,hed nth,, New Card Same R & T Type of 118 1 #1 1 F -at 8 2 C 0 z M ' 261 - F P Z Dow FOOT NOTES S. --ce of Data Cod.., t—i-ncy of C.11ic,— Cod --s S D 0 A A L G z A B C 0 0 S Type cfLog Codes C T U z J K L 0 p C "Y 6 C D E F G H i K -fes. and n. L r,EOHVDROLOGIC UNIT DESCRIPTIONS (11 R�90 • T A D M s 258 # p If i th to Iw t111 ,• I ���7 i •i � t Bottom add. dares•, modify unit 7 T " LiothoLlog�c 97. MdreLithology J -1 U , Gb—iSdenufrer 21 0 � � AQUIFER DATA (2) T- A O 1;7* Goohydrologic 258 # • Unit Entry No add. d0•te. modify 95 # Date 1 I- / 1 * 126 = Water Level I 1 i i i i I I Water 732 = • Contributed ontributed wrnnth day year GEOHVDROLOGIC UNIT DESCRIPTIONS 111 T- R• f 0 • T• D M• Entry 25g jj * Depth 9 1 Depth to 92- No to Top '�'T• Bottom add.dalete.modty Unit 93� Identifier �''tt /Y # ��,----'---"--"-' 96= iC%! p/ �twi Lilholo -_ ___�S__ — Lithologic--T-- 97= Modifier _.--- f -- -- �= %�C 'M.E,t/' //''��yy //IC'f+ *' _i = ___ . _ -_._ _' ./I_K _47 3�y- Yk AQUIFER DATA (21 R = 9• #T A D M ♦ Goohydrologic 258 # LMit Entry No add, delete. madly 95#1/1 0/ ) / $ i y s ,z6 3 %Water Data, Water Level 1 Contributed rromh 6Y Yaer PERTINENT REMARKS 31 /'# / 4' add New Card Same R6T � � ' � � 1 i 1 1 I 1 I I i i i I i i i i 1 185= � � t: NOTES: _. S. GOVERNMEN7 i HINT INC '* FLC'F: V -,f. O -213-1J7 WRD Exp. (GW) April 1966 U. S. DEPT, OF THE INTERIOR Well No._ ^ a 7 jI. WELL SCHEDULE GEOLOGICAL SURVEY WATER RESOURCES DIVISION MASTER CARD Source Record by•L .�f�eiwzi' of data It Off- Date �" A/6�/ MMapp�! State ,7 /, b : O (oor toown)/Y�/7%7O 1 1 1 7 N Sequential D Latitude• s� 7 min/ ♦�aec �y' S Longitude: ' , / - 1 number: 12 degrees 15 min sec is 16 Lat-longN E accuracy: 7o T. �J S, R.3 v, Sec ? r calOther wellonumbar- e7 ; �' }�� i i V ��' ' G.= ' �� ' ' ,i number• B 6 M Local as: OIA / ' ' 1 ' F - . Owner Z eon 631 r� s-' „7 ,:Si C7 zd ,L�/rJ Owner or name: G T: ;r;& 5: :,44ht'71L i/f: Address: 0 /4 �✓Ia 37 s° 61 66 (C) (F) (M) (N) (P) (s) & t �1 ifl0/171i�,� Ownership: County, Fed Gov't, City, Corp or , private State Agency, Water Dist 67 (A) (B) (C) (D) (E) (F)(H) I) (M) (N) (P) (R) Use of Air cond, Bottling, Comm, Dewater, Power, Fir , Dom rr, Med, Ind, P S, Rec, water: (S) (T) (U) (V) (W) (x) (Y) ($) Stock, Instit, Unused, Repressure, Recharge, Desal-P S, Desal-other, Other °s© Use of (A) (D) (G) (H) (a) (P) (R) (T) (U) (W) (7C) (;;) 69Q Le Anode, Drain, Seismic, Heat Res, Obs, Oil -gas, Recharge, Test, Unus Withdraw asce, Destroyed DATA AVAILABLE: Well datao Freq. W/L meas.: Field aquifer char .7Z a 70 71 Hyd. lab. data: Qual. water data; type: Freq. sampling: Aperture cards: Log data: WEL L-DESCRIP TION CARD F-1 Yes Pumpage inventory: no, period: 7s ye 77F� 76a 76F-1 6 77a f SAME AS ON MASTER CARDDepth well: / V ft , , Meas. 76 1v 70 Depch cased• 1 Casing yerf.j 7s rept accuracy (first pft I type: Diam. _�in 73 1 (N) (m) P) (S) ST) Finish: poioue grave v. grave w. horiz open erf., screen, s 7V (W) (X) (11) , pt., shored, p@n concrete, (perf.) , (screen) galler end dole, Method (A) (B) (C) (D) (H) (J) (P) (R) (T) o[ a—fir (V) (W) (>_) Drilled: air bored, cable, dug, hyd jetted, air reverse trenching, driven, drive rot, rot., percussion, rotary, wash,ot— e — sl Date / Drilled.• �0 (p Pump intake setting: It 13 1s 36 1e Driller: �a Lift "a0e (L) (A) (B) (C) (J) ISN) (P) (R) ress (S) (T) (S) Deep multiple, mulci)ple, (type): air, bucket, cent, jet, (cent.) (curb.) none, piston, rot, submerg, turb, other F-1Shallow a Power net LP 39 Trans. or (type): diesel, elec, gas, gasoline, hand, gas, wind; H.P. meter no. C`above 61 Descrip. MP It below LSD Alt. MP Accuracy: Alt. LSD: l � � source 67a Water above 67 above -66 ' s Level ft below MP: Ft below LSD Accuracy: Dace 6s si / m_as: 4 7 ss ss Yield: (� gpm Method i determined n 76 ep , Pumping 'Drawdown: �_ft ° ' Accuracy: period �_. hrs QUALITY OF 06 63 WATER DATA: Iron Sulfate F7Chloride 6i 62 E Hard.n ppm 6s ppm 70 Dated 71 ppm Sp. Conduct K x 106F7 Temp. •F sampled 73 76 76 77 7V color, etc. 04 -//cam 0 �1 s`� Well No. Latitude -longitude �� , s1�-� S��/- d m s d IS • HYDROGEOLOGIC CARD Physiographic SANE AS ON ;ASTER CARD Province: Section: I n20 ❑Dra_.in: as n• 21 l D 1 Subbasin: 22 13 23 (D) - (C) (B) (f) (N) (R) (L) Topo of depression, stream channel, dunes, flat, hilltop, sink, avamp. veil site; (0) (P) (g) (T) (D) (V) offshore, pediment, hillside, terrace, undulating, valley flat 27 MAJOR 1 1 UIFER: system ser as 2♦ aquifer, formation, group sm 0 Aquifer Lithology: Origin: sa Thickness: ft Length of rTT1 Depen I � © Well open to: ft ss ' 1 � top of:: ft�� ii �s ss 37 MINOR UIFER: system aeries aquifer, formation, group 46 A7 Aquifer Lithology: am1�� Origin: Thickness: ft 1 Length so Depth to 1 1 © well openen to: ft [op of:: ft 51 s2 . 57 ss Intervals Screened: Depth to 1 D 64 consolidated rock- ft ss i Source of data: Depth to 1 1 am a basement: ft Source of data: Surficial s � •Infiltration 170—L 72 material: J characteristics: 4•— Coefficient I 1 - Coefficient 1 Trans: gpd/ft Storage: Coefficient 7a 7s 2 Perm- gpd/ft Spec sap: gpm/f t; Number of geologic cards: 71 -2q— $ (v �j r.cy �i ;// SIB S- 'A — f G �,1„c . S � — I( C4 i GPO 857-700