HomeMy WebLinkAboutUS SURVEY 3044 LT 60 T10N R2E SEC 17/18CESS 4143cptetk
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E't, Wit,
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 075-061-48 Expiration Date:
s/y
1. GENERAL INFORMATION
Complete legal description USS 3044, Lot 60 'TON R2-€ SEC. Pp
Location (site address) 1714 Alyeska Highway, Girdwood AK
Current Property owner(s) Terrence & Shari Kayutak Day phone
Mailing address PO Box 1005 Girdwood, AK 99587
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Ej Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well 0 Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ELI
—
3
saJAN
13 2714
TYPE OF WASTEWATER DISPOSAL:
WaiverNariance request for: Distance:
Received by:, f`
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date: ' l/
COSA Fee $ 5 6 . `" Waiver Fee $
Date of Payment / /l tit t Date of Payment
Receipt Number 0(04.35-6) Receipt Number
COSA# Oc56/4/0116, Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
By:
Phone (907)272-8218
Date 12/23/13
�-oatitr��
*,49TM » *'
000 §even l5annon
bedrooms, with the following stipulations:
tttitlll ccur fr/r{
ON-SITE
WATER AND
a WASTEWATER oz^
S PROGRAM N`
qma_ C �`
-moi, F4:,-rn\I\C;�
ovvv0/(41/1bry
Original Certificate Date:
The M7rtI"cipality of Anchorage 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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet_E
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Uss 3044, Lot 60 Parcel ID: 075-061-48
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g,p.m.
WATER SAMPLE RESULTS:
Coliform /V colonies/100 mL Nitrate 6, S 3 7 mg/L
Arsenic /U) ug/L Date of sample: 1)1).0/1cs 1
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) _ Depression over tank (Y/N)
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
12/20/13
36 ft
5.2+
g.p.m.
Collected by: /` li ?
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed
Length
Total depth
Soil rating (g.p.d./ft2 or ft2/bdrm)
ft. Width
ft. Eff. absorption area ft2 Monitoring tube _ Depression over field
System type
ft. Gravel below pipe
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test in. Water added
Elapsed Time:
min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
ft.
For bedrooms
gal. New depth in.
Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off" evel at
Datum Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO: /
Septic tank/lift station on lot N 1,
Absorption field on lot
Public sewer main 75+
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots 100+
On adjacent lots 100+
100+
Public sewer manhole/cleanout
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain
F. COMMENTS
Building foundation
Surface water
Wells on adjacent lots
Absorption field
Surface water
Water main
Driveway, parking/vehicle storage
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 12/23/13
COSA brown sheet 10-10-12.doc
. DE -8149
jo�Aa ss
S-1039
NOTE:
THIS DRAWING
PLAN WITHOUT
Legal Description;
AS -BUILT
Lot 60
USS 113044
LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS
440 West Benson Boulevard, Suite 200 Phone: 562-5291
Anchorage, Alaska 99503 Fax: 561-6626
Plat: USS 3044
work Orde: 2014-1-01
Ink/I39: 792/66
Grid: 4814
Ordered By.
SHALL NOT BE MODIFIED FOR USE AS A PLOT
THE EXPRESSED WRITTEN CONSENT OF LANTECH.
MORGAN M1CHELSJHN
Legend:
Septic Standpipe
Water We
Pince—x—x—
Asphalt
SURVEY CERTIFICA11QN: LANTECH ha conducted a physical survey of the
property os shown on this drawing and certhies that the Improvements
situated thereon are within the property Ones and no encroachments Sat
other Than noted
EXCLUSIONARY NOTE: It is the owners' responsibility to determine the
existence of any easements, covenants, restrictions or right—of—way
takings which do not captor on the recorded subdivision plat. Under
no circumstances should any data hereon be used for construction,
for establishing property linos, or for plot—pion purposes.
Data. JANUARY 10, 2014 fOrown By. DMD
Scale: 1"=40' (checked By. TAE
MUNICIPALITY OF ANCHORAGE -
DEPARTMENt OF HEALTH & HUMAN SERVICES
Division of Environmental Services''
On Site Service's Section;;
.0. Boz 196650 CAnchorage'Alaska .`99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 075-061 -48 HAA # �1 QC\clf�(nLt
1. GENERAL INFORMATION
Complete legal description
U.S. Survey 3044; Lot
Location (site address or directions)
Alyeska Highway
Property owner Mikeyand Louise Lane Day phone 783-2126
Mailing address
Lending agency Day phone
Mailing address
Agent George McCoy w/ Jack White Real Est. Day phone 783-2937
Address 3201 C Street, Suite 100 Anchorage; AK 99503
Unless otherwise requested, HAA will be held for pickup.
2
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XX
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 XX
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
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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 dat this inspection.
Name of FirmALA81iAWAgR =�; -,� h'1`L}t phone 337' 617 9
•�N i•T•yr i:,INS,
Address •901 uE'6 aT►' , S 2B
Engineer's signature
6. DHHS SIGNATURE
)� Approved for 2 bedrooms.
Disapproved.
1/49 h
*
0
of r A:G: ea?, ? .Wd
• E-7953 V�p®
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By 0641__
Date 2-7-99
CAUTION
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
D. LIFT STATION iJ/A
Date installed Size in gallons
Manhole/Access ( ' "Pump on" le - - "Pump off" level at*
High water alarm level at*
Cycl
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot '� On adjacent lots r1/4
Absorption field on lot n1 /Oc On adjacent lots
Public sewer main 1 oat '1' Public sewer manhole/cleanout
Sewer /septic service line 2.5,-1-
0/A
Lift station 4 bA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Poe ur
Foundation
Water
u-1 •-
Property line__________---,t4sefptioirfreTC
Surface water/drainage
Wells on adjacent o s
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: 9013UL
Prope
Surface water
Curtai
F. ENGINEER'S CERTIFICATION
Building foundation
SEw1
Water ma line
rking/vehicle storage area
Wells on adjacent lots
I certify that
in conform
Signature
Engineer's Name
Date 2-09I3
Id inspections and review of Municipal rev
nes in effect on this date.
q)st pre
HAA Fee $ U OD ' 57)
Waiver Fee $
Date of Payment (] 2 -/b2 -k/ Date of Payment
%I�
Receipt Number 114-70 l c 2-80/l Receipt Number
72-026 (Rev. 3/96)*
RECEIVED
Municipality of Anchorage FEB 02 1999
. 1
DEPARTMENT OF HEALTH & HUMAN SERVIC�mSNiclaAury oFANcrlo• I .:
Environmental Services Division ENVIRONMENTAL SERVICES DIatria_
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: U.5. SuRJef 304°1 LoT L.O Parcel I.D.: 015 - oral - 48
A. WELL DATA
Well type PRNtyre If A, B, or C, attach ADEC letter. ADEC water system number -'—
Log present (Y,(f, Ni 0 Date completed U • K • &12f2t'`''r• 7979
Total depth U.K. Cased to 4ol+ Casing height (above ground)
ef• •
/a 71-
Sanitary
f
Sanitary seal MN) `{res Wires properly protected ON) Yrs
AT INSPECTION
I/Zo/9
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG
g.p.m.
3L
g.p.m.
Coliform Nitrate 0.485 m54 Other bacteria S'
Date of sample: I /Z.I An Collected by: h.v.-\• 0 • c , I rJc .
B. SEPTIC/HOLDING TANK DATA pusLIL SEWER
Date installed • Tank size Num partments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression -MN)
Date of P mpin� g Pumper
C. ABSORPTION FIELD DATA Pogo c-
svJE2
h water alarm (Y/N)
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length ' . Gravel thickness below pipe Total depth
Effective absorption area Monito be pr- - /N) Depression over field (Y/N)
Date of adequacy test R s (Pass/Fail) For bedrooms
Fluid depth in absorption field b> . e test (in.); Immediately after ga . .ter added (in.):
Fluid depth (ins) Minutes later: Absorption rate =
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3196)*
If yes, give date
JAN -28-99 08:10
FROM -CTE ENVIRONMENTAL 5615301 T-512 P.02/03 F-669
CS&b Environmental Services Inc.
raisiessresso
CT&E ReT.A
Client Name
Project Name/A
Client Sample m
Matrix
Ordered By
PW'SAD
990323001
AK Water $r Wastewater Consultants Inc_
U.S Survey 3044 Lot 60
U.S Survey 3044 Lot 60
Drinking Water
0
Client PON
Printed Date/Time 01/27;99 00:52
Collected Date/Tiate 01/21/99 12 30
Received Date/Time 01/21/99 13:10
Technical Director: Stephen C. Ede
Released 13y p
cA
Sample Remarks:
Parameter
Tara; Coliform
Nitrate -1i
Resutza PCL units method
0
0.485
co:/l00mL
0.100 mt1/L
ALLawadLc Prep Anaty4i4
Limits pate bare mit
Sm18 92228
EPA 300.0
01/21199 KAP
10 max 01/21/99 01/21/99 SCE
RECEIVED
FEB 2 1999
Municipality of Anchorage
Dept. Health & Human Services
4. DIAMETER -
CULVERT PIPE
EXISTING PROFILE OF WELL
100.35 -
100.36
101.8
I
1 P SURFACE OF DRNEWAY
r\ \\/\\r%�/%rr%�/%\�{\�{\.
PROP PROFILE OF WELL 4.—P'`r'�'S
EXTEND WELL HEAD TO--�,
ABOVE GRADE
lig12,4,!> r- 101.0
C iALVe4 r
100.38
Y 17 ////////
tixsslH\ i /rrr/\% // j///4ii
r�ij ij,r,
FILL CULVERT WITH
SOIL TO BE FLUSH
WITH ELEVATION OF
THE DRIVEWAY OR
HIGHER
SURFACE OF DRIVEWAY
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD. SUITE 2B. ANCHORAGE, AK, 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
LEGAL DESCRIPTION:
U.S. SURVEY 3044, LOT 60
TYPE OF WORK:
PROFILE OF WELL
PREPARED FOR:
MIKE AND LOUISE LANE
DATE:
DRAWN BY:
A.C.G.
2/9/99
PHONE NUMBER:
793-2126
ISCALE: I PAGE:
N.T.S. 1 OF 1
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
ontiersi
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I D # (V) 010 \ — L -i (l HAA # ()C\nnCl
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 60; U.S.S.# 3044
Location (address or directions)
Atgeaka Highway
(b) Property owner
Mailing Address 7021 DAL .twoad Anchoh.a' e Ata6ka 99518
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent JACK (UNITE COMPANY ATTN: Jack Vandenbeh.g
Address 3201 C S.#nee- Suite 100 Anckonctge, A2abka 99503
Telephone 563-5500
(e) Mail the HAA to the following address: (or check here Mif hold for pick up.)
List contact person and day phone number below:
DESIGNS IN WUOOD Telephone : (home)
Scan ILLU
Business
S &S ENGINEERING
ad -No --2a
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family M Number of bedrooms
3. WATER SUPPLY
Individual Well Dlx
1
Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 0 Public Rix Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88)
Page 1 of 2
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 Authority Approval 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. 1 further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection. J
Name of Firm Telephone egcrt Z f7 zi
g w $ :ifd'fYINtiRING
Address Jr:31. Eagle. River Loop Road No. 204
E:agla River, Alaska 9951/
Date yZ// / J J
6. DHHS APPROVAL
Approved for / bedrooms by
Approved Disapproved
Terms of Conditional Approval _C)/IIE
Cad,`a,.
23 , 61y{t
SO 'al' 34
1:4;. 1151-i a
1-41—Date C)
' _ / �����
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back
Page 2 of 2
N`Cwp EN P� E�
,�o\l N(1(3%
A. WELL DATAt��c,,� `v
Well Classification 51Ny la fr Ann; ll If A, B, C, D.E.C. Approved (Y/N) a
Well Log Present (Y/N) /J Date Completed U I{ Yield e. 9 l p M
Total Depth LI I( Cased to 4o t Depth of Grouting — ( 11- q- yo)
Static Water Level 34' Pump Set At Ul<-
Casing Height Above Ground l7 r' t Sanitary Seal on Casing (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA)
ON Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description' Lo+ Go Q. s. S tfr 3 014
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot Ni/PI
To Nearest Edge of Absorption Field on Lot M/W
LI
Depression Around Wellhead (Y/N) /J
; On Adjoining Lots
1 00 1 ±
; On Adjoining Lots f p0 /-t
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole / 00
To Nearest Sewer Service Line on Lot 2 S
Water Sample Collected by .� 'f' � Fn./ r ; Date 1 ! - 5 - `( 0 L
WaterSampleTestResults 5H its fAc.tnr'9 - Qf�OfeViV� 'F /Ott-ei/ ISS
Comments PutI ee(.�eV'
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contact on e (Y/N) ; for
Holding Tank High -Water Alar nj (,Y/N) & Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/' •LDING TANK:
To Water -Supply Well To Building Foundation
To Property Line To Disposal Field
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in AbsorptioStrata Type of System Design
Date Installed Length of Field
Width of Field Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area ► Statndpipes Present (Y/N)
Depression over Field (Y/N) Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION F D.
To Water -Supply Well To Property Line
To Building Foundation To Existing or Abandoned System on
Lot ; On Adjoinin. ots
To Water Main/Service Line To Cutb•ck (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments u b (l r_ e W e r
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at
I ' v ) Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ii th'- a:
inspection.
S s1M( IN EKING
Signed17034 tingle River Loop Road No vO4
Company Eagle River, Alaska 99577
Date /1/73/#7
MOA No. CP2 go — Cc
Receipt No. 33 !� C3& �d" / Receipt No
Date of Payment / / —( J - ?a Waiver Fee; $
Amount; $ / 2 o. 0 () Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
)k..
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
:=mea,
5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order 4 30025
Date Report Printed: NOV 13 90 @ 09:50
Client Sample ID:L60 USS 43044
PWSID :UA
Collected NOV 9 90 @ 13:30 hrs.
Received NOV 9 90 @ 16:22 hrs.
Preserved with :AS REQUIRED
Analysis Completed :NOV 12 90
Laboratory Supexv1ispx :STEPHEN C. EDE
Released By :
L
Special 'FAX TO ROGER @ 4694-1211.
Instruct:
Chemlab Ref 4: 904777 Lab Smpl ID: 1
Parameter Tested
Matrix: WATER
Result Units
Client Name : S & S ENGINEERING
Client Acct : SNSENGP
P.0.4 NONE RECEIVED
Req 4
Ordered By : R. SHAFER
Send Reports to:
1)S & S ENGINEERING
2)
Method
Allowable
Limits
NITRATE -N
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY R.D.J.
0.13 mg/1 EPA 353.2 10
1 Tests Performed ' See Special Instructions Above UA=Unavailable
ND= None Detected " See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
FINER At I
PROJECT: j RCI UCH' TL �' 0 kmakil%nxdeoi3ory DATE OF TEST:
LOCATION OF WELL (Legal Description): / t L, 0 - O S S . 2,04/4
WELL DEPTH: ( FT CASING: .qQ t FT. SCREEN:
17034 Eagle River Loop Road ROBERT A. SHAFER
Eagle River, Alaska 99577
CIVIL ENGINEER
694.2979
(1-9-ta
DATE DRILLING COMPLETED: 17 K
DRILLER. U IC
STATIC WATER LEVEL (Top of Casing): 4 FT. DATE / I " `/ -q O
CLOCK
TIME
eA
ELAPSED TIME SINCE
PUMPING STARTED/
STOPPED, MIN.
DEPTH TO
WATER, FT.
DRAWDOWN/
. RECOVERY
PUMPING
RATE, GPM
REMARKS
11 o0
0
3 Li
(swl)
0
0
Start (- (0(,,..)coto (-„
1
P 9
t� tp i t t-9,-1 to 11 tb o M
oc
5
C( 1
8 9
in
_size /a%on P/0,44.11/N9
10
10
41
g�
Iry
15
4 I
R. y9
20
20
41
5:3,q
25-
25.
4 (
R 9
30
30
4(
61
3S-
35
4 1
R g
4v
40
`i 1
g. i
4I.S
45
hi I
/3.`I
ro
50
41
al
SS
55
41
Al
12 00
60(1 hour)
41
R.9
zo
90
c(1
gig
120 (2 hours)
150
180 (3 hours)
210
15 co
240 (4 hours)
4 1
1-
6.9
RECOVERY
t 0
0
5
10
15
20
25
30
35
Comments:
We(( p(ocloce S MINE MuYA of 8.T geN,
C,ue,r A q k0tDit pei1Od
FIOW 111 i9elf uuaranrn
Sbbsequent Variations
Can Occur,