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Home My WebLink AboutSAND LAKE #2 BLK 1 LT 12Sand Lake Block Lot 12 #011'132 -37 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231025 PID Number: 011-132-37 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name TROY BIERING ABSORPTION FIELD X Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5135 WEST 82ND AVENUE *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 907-244-8420 3 1.2 GPD/SF JTotal 12.25 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 6.5 Ft. Subdivision Block Lot SAND LAKE #2; BLOCK 1, LOT 12 Fill added above original grade SEE DWG. Ft. Gravel length 29 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 377 Ft z 1 - Ft. Well *80'+ *80'+ - - 25'+ TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity INFILTRATOR 1060 Gal. Surface Water 100'+ 100'+ - - Material Number of compartments Lot Line 5'+ _ _ NA PLASTIC 2 Foundation 10'+ 10'+ _ _ LIFT STATION Manufacturer Capacity Remarks PER CONTRACTOR OLD TANK DECOMISSIONED PER UPC Gal. "OSV231009 !� Z,7 Alarm location Electrical installed by Installer PIPE MATERIAL House to tank EXISTIN drainfield Tank to D3034 ARM SEPTIC SERVICES Drainfield D3034 CO/MTD3034 Inspector GEG AND M.O.A. BENCH MARK (Assumed elevation) 100.00 ft Inspection ection 1" 6/19/2023 Zia 6/19/2023 Location and description 31d 6/20/201e' 41 - BOTTOM OF VERTICAL TRIM AT SOUTHEAST CORNER OF HOUSE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp :7 OF pop Conditional Approval: Date oo � ..... Q r0 ter, �., T"Nc � .T L ,,�►. 1� ; ST��-I. .............P Septic System r Z�9� Approved 4� / 5/�Z3 CE— g a Hess,=�`o�p 0 s a Date �;3 ;� 44 •,. • • r/� � I� O eco, afro Note: this approval does not include well permit requirements. fesS'j0(% D�pOOo #AECC884 4 trcev vo�uzr its/ Ci 16/21/-23 JV J9(z93i �_P �� -,PlaU� PERMIT NUMBER: OSP231025 PARCEL ID NUMBER: RECORD DRAWING 011-132-37 A B \ FCO 8.6 16.1 \ MH1 24.6 25.6 \ ST1 22.8 28.8 \ DBL7 22.4 31.1 \ DBI-2 22.5 31.7 FD 22.7 32.6 C01 18.7 14.7 MT1 18.1 14.2 \ CO2 17.8 39.0 MT2 18.5 39.4 LOT 11, BLOCK1; LOT 14, BLOCK 1; NOTE: PIPE LOCATIONS ARE —" ~� \ SAND LAKE SID,112 SAND LAKE SID #2 SHOWN PER THE .DWG FILE PROVIDED BY SHANE HOLT, GENERAL LOCATION OF WATER LINE (NOT \ PLS - ASBUILT SURVEY IS SURVEYED) PROFESSIONALLY LOCATED BY ARCTIC ATTACHED EFFLUENT PRIOR TO CONSTRUCTION; NEW SEPTIC TANK AND DRAINFIELD ARE 10'+ FROM WATER LINE. NEW INFILTRATOR IM-1060 SEPTIC TANK 7 — ' — B SHED I LOT 13, BLOCK 1; SAND LAKE S/D # 80' WECt MTII l C01 7R4DjUS _ wR OSV23 FCO Q MH1 1009 O ST1 / DBL1& ✓` e e 4 Aq 4 'aa / CO MTZ SHED ----------------a=— ° d -- DRAINFIELD //NEW WEST 82ND AVENUE ------------ = -------------------- N S ALE: 1"=20' } AA1�E IiI iiIJP', Load .......... 4W •• ; :............. ..� �.....' ENGINEERING z, SALES � CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, ALASKA' PHONE (907) 337-6179 • WEBSITE w.vwgamessengmeenng can �, .. ...... 0 . ... nu.. . un. ; (n '. J rey A • eSS1 PREPARED FOR: PHONE NUMBER: PAGE NUMBER. TROY BIERING 907-244-8420 2 OF 3 %,',•• C -7952 SAV �♦ �••. ,•�� PROJECT/LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2; BLOCK 1, LOT 12 D.J.G. ##Fpal•�••• •.•...•. ,''•P�, �� `�►�� 1 ESS\LICENS TYPE OF WORK: DATE: SEPTIC TANK AND DRAINFIELD RECORD DRAWING 6/26/2023 #AECC884 PER OSP231025 IRECORD DRAWING 231025 TOP OF MH = 99.87 FINAL GRADE = 99.43-99.57 MH1 ST1 TOP OF TANK AT INLET = 95.21 INVERT OF BUNG AT INLET = 94.70 2" INSULATION PER CONTRACTOR 060 2 -COMPARTMENT TRATOR SEPTIC TANK MT CO ORIGINAL GRADE AT HIGHEST POINT = 99.69 6.5 FEET RELATIVE ELEVATION OF 2001 TESTHOLE IN MOA RECORDS = 80.69 T.H. DRY ON 6/22/2001 - PER 2001 INSPECTION REPORT, TH WAS DEEPENED TO 19 FEET - TOP OF TANK AT OUTLET = 95.20 PARCEL ID NUMBER: 011-132-37 INVERT OF BUNG AT OUTLET = 94.36 FINAL GRADE = 99.31-99.97 FILTER FABRIC OF PIPE = 93.94 BOTTOM OF TRENCH ELEVATION = 87.44 ... o ENGINEERING- SALES, CONSULTING 3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE, AK 99507' PHONE (907) 337-6179 • FAX (907) 336-3246' WEBSITE: —game sengi—nng—m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TROY BIERING 907-244-8420 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2; BLOCK 1, LOT 12 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK PROFILE 6/26/2026 .... ....................., •�Ar 40 #Fo . Z6 2P��.•' LICENSE444'' „SS\ ,, �w #AECC884 MUNICIPALITY OF ANCHORAGE "»ent On -Site Water & Wastewater Program �o� S� PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite v Departmcnt On -Site Wastewater Disposal System Permit Permit Number: OSP231025 Effective Date: 3/20/2023 Work Type: Septic Upgrade Expiration Date: 3/19/2024 Tax Code Number: 01113237000 Site Legal Address: SAND LAKE #2 BLK 1 LT 12 G:2224 Site Mailing Address: 5135 W 82ND AVE, Anchorage Owner: BIERING TROY & SUSAN Lot Size in Sq Ft: 6750 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Prior to construction, locate the water line that follows the north property line to ensure that the required separation to the proposed tank and field is met. 2. The contractor is clean and/or repair the south cleanout. Remiv�: jp5 5 (AeA +0 (r— Issued By: Date: Date: 3��2 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 Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231009 COSA#: Permit#:OSP231025 PID#: 011-132-37 Legal Description: SAND LAKE #2 B1 L12 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance is 80.0 feet. This waiver approval applies to the proposed absorption field and septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: Zo Z3 Approved by:�— Name of Revievy ..........................................................'r..................' **** VARIANCE/WAIVER REVIEW **** UMUPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-132-37 Property owner(s) TROY BIERING Mailing address 5135 WEST 82ND *ANCHORAGE, AK Site address 5135 WEST 82ND *ANCHORAGE, AK Day phone 907-244-8420 Legal description (Sub'd., Block & Lot) SAND LAKE #2; BLOCK 1, LOT 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fxj Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TANK AND DRAINFIELD TO WELL Distance: 80 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: 1120 Date of Payment: T 6 Date of Payment: 0 13/--L6',z3 Receipt Number: Receipt Number: Permit No. Q S P �1 ��r Waiver No. ®S\(a i GADevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231025, Deb Wockenfuss, 03/20/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231025, Deb Wockenfuss, 03/20/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231025, Deb Wockenfuss, 03/20/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231025, Deb Wockenfuss, 03/20/23 49 1H- SHANEA. HOLT LS -6914 Q�aA '�'°fessioW L O O W O O i cv iy �sn.� nnry i�vnr1 WEST 82 ND EL EC EA SEMEN T A FFEC IS THE 5'A NO THE EAST IO' RECORDED AT BOOK 1251, PAGE 870 A VENUE AS—BUILT SURVEY NO CORNERS SET THIS DATE SCALE 1 ^ = 20 FENCE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT12 BLOCK2SAND LAKEN0.2 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT ARE NOT SHOWN EXIST OTHER THAN NOTED. I HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA THIS 6TH DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS• FEBRUARY , 2023 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE• ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON 15727 228-14 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 907-223-8615 Municipality of Anchorage ..,--: ...:-% Development Services Department .-'~ = ~., Building Safety Division Or.Site Water & Wastevmter Program, 4700 South Bragaw SL P.O. Box 196650 A~chorage, AK 99519.-6650 www.d.a~chorage.ak.u$ (907) 343-7904 Poge 1 of On-Site Wastewater Disposal System and/or Wall Inspection Report Permit Number:, SW010:~40 PID Number:, 011 --152--57 N°me:KAREN TILDE WastewaterSyetem: 0 New · Upgrode Addre~e: 5155 w. 82ND ^V[NUE · ANCHORACE, AK 99502 ABSORPTION FIELD NO, of ~edrooml: Ph°ne:(907) 248--5987 5 · ~.p Tr..ch [] Sho,o. Tr.~h O e.d [] ~4o..d LEGAL DESCRIPTION '~ ~ 1.2 ~/~ r~ 10.71-12.72~ 12 I SAND LAKE ~/2 5.64-5.65 ~ 7.07 - - - 0.82-1.26 ~ 27.5 WELL: [] New [] Upgrode 2.0+ r~ 1 ~.. r~ r~ 589 s=. r~ D 5054/ F-810 r~ A+ HOME/SERVICES 9/10-11/01 SEPARATION DISTANCES .5,~u~ •Holding ~ S.T.E.P. •Other ~o s.,uc A~.~.~dUo. ~ Hok~.gs~...~ ANCHORAGE TANK 1000 Well 100'+ 100'+ - - 25'+ STEEL 2 s~oc. wot°, ~oo'+ ~oo'+ - - - LIFT STATION cu o, .o,.E K.OW · ~o~k,: -EX~S~NO SEP~C SYST[~ ~NDONED BENCH MARK PER UPC TOP OF CONRETE SUPPORT ON WEST SIDE OF · LOT UNE WANER ISSUED (PERMIT ~SW010540) CARPORT · TEST HOLE DEEPENED TO 19' ON 9/10/01 NO I*"~"'d c-~-'-~ 100.00 BEDROCK OR GROUNDWATER FOUND ~.~=.'~.~_~%,~ L ^wwc. ,NO. D te :,s, ......... ti. ...... 2nd 9/lO/2OOl ~ .,.. ,,'/ ....... '~'::'"~ ~rd 9/~1/2001 ~,,~.:~r~, ~.~o~o~.: Department of Health and Human Services approval,, v~ ~or"' g..~' ~. -?~,'.:....... e~an' auue~: AS B'L~T D~~G p~c~.mo SW010~40 - 011-152-~7 / / / X I ~-.,~,/ 5I ~ ~ __ 71- ~ X / ~ ~{ h~//DBL4 / ~/~7/~oo~ ~-.~[..~ EX~S~N¢ 3 BEDROOM HOUSE B C.J.O. ALASKA WATER & WASTEWATER~ CONSULTANTS, INC. 1 # ---- 30' KAREN TIEDE (907) 248-3987 2 OF 3 SAND LAKE SUBDIVISION 11~2; LOT 12. BLOCK 1, AS-BUILT DRAWING OF' SEPTIC SYSTEM UPGRADE ,~.U~B~ AS--BUILT DRAWING SWO10540 O11-152-~57 TOP OF..TgAt~? AT.--~ = = ~TOP Or T~K AT - ' ' - N~ 1000 ~ or BUNO SEP~C TANK I~ OF BUNG AT AT IN~ - 93.57 ~ ~ O~ -- 93.36 OR,~ ~ 9/17/2001 ~e n c.J.O. ~S~ WATER & WASTEWATER ~ co~SULT~mS, ,~c. , .~, ~ ~ ~ ~.~.. ~ ~,~.~.o,~,,.,...~ ~.o,~, ~.T.~. "" ~"~ '7 ~ ..... ~ ...... KAREN TIEDE (907) 248-3907 * OF 5 SAND ~KE SUBDIVISION ~2; LOT 12. BLOCK 1, PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Development Services Department . On-Site Water& WastewaterProgram 4700 South Bmgaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 27, 2001 Expiration Date: Aug 27, 2002 Permit Number: SW010340 :Legal Description: SAND LAKE #2 BLK 1 LT 12 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Karen Tiede Owner Address: 5135 W 82ND AVE ANCHORAGE , AK 99502-4121 Parcel ID: 011-132-37 Site Address: 005135 82ND AVE W Lot Size: 6750 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The 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, s~aled, and heated to prevent freezing. Received By: ,,~ ~j~O '~LO~/~ Date: Municipality 6f Anchorage Development Services Department Building Safety Division On-Site Water & Wasfewater Program 4700 South Bmgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak, us (907) 34379O4 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Ol1-132-37 Permit Number Property owner(s) KAREN TIEOE Dayphone 830-3876 Mailing address (1) 5135 W. 82nd AVENUE Mailing address (2) ANCHORAGE. AK Zip Code Legaldescripflon(Lot, Block&Sub'd.) ~AND LAKE ~2: LOT 12. BLOCK 1 Legal description (Section, Township & Range) Lot Size ~, 7 ~ Acms/Sq.FL Number of Bedrooms 99502 THIS APPLICATION IS FOR: Sewer Only ~E] Sewer and Well Sewer Upgrade · Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub [~ Swimming Pool Therapy Pool [] Jac Water Softening Unit 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. ALASKA WATER &: WASTE'WATER CONSULTANTS~ INC. Permit Fees: ,.~ Date of Payment: Receipt Number:, Waiver Fees: ..~ Date of Payment: Receipt Number:. ALASKA WATER & WASTEWATER CONSULTANTS, INC. July 1 !, 2001 Municipality of Anchomge Deparlment of Development Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic System Upgrade for Lot 12, Block 1, Sand Lake Subdivision #2 To whom it may concern: The existing 3 bedroom house is served by a class "C" well and a private septic system. The existing septic system consist of a 1000 gallon septic tank and a crib type drainfield. The existing dminfield is surcharged and must be upgraded. A test hole was excavated south of the existing septic system in the area of the proposed septic upgrade. The proposed septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.2 gallons/day/ft2 should be used. 2. TRENCtl DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons~day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. Total Depth: 11 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 27 feet k. Effective absorption area ~ 378 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwxvc.com 4. TOPOGRAPIIY: The topography of this property generally fiat; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. 5. WAIVERS: Due to the very limited space available on the lot for a septic system upgrade, we have requested waivers from the existing class C well on the property to the proposed septic tank and drainfield. A copy of the letter to ADEC is attached. We will provide a copy of the waiver to you prior to issuance of the sewer permit by your department. In addition to the ADEC waivers, we are requesting a I foot separation distance waiver to the south property line, a 5 feet separation distance waiver from the proposed tank to the east lot line, and an 8 feet separation distance waiver from the east property line to the proposed drainfield. The south property line adjoins a road fight-of-way. There is a recorded 10' easement along the east property line. Letters of non-objection are being requested and will be provided to your office as soon as they are acquired. In short, there are no adverse impacts associated with granting this waiver. A $115.00 waiver review fee was submitted with this permit application. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com LOT 3. BU~C~ 2; U;T 22. B~C~ 2: I LOT , ~ ,. ~, ,. ~V~ ,,. ~ ,, J ~0 ~ s/o ]2 ~o ~ s~ t2 , ~ ~ )~ J , ~ ~ ~ '-~ ~ ........ ~S/DIZ y ~O~S/Ol2 ~ ~ / / ~' ~U~Y~D~= ' I / W~ B~O A~NUE~ ~~__ ~-~ / Ii / // ~ // J / ~ ~ ~_ ~ S~C I I / J Y, F ....... ~.W.~. ~SI~ ~I'I&R & ~STE~TER CONSUkTANT$, lNG. ~ PR~ED FOR P~NE NUMBm: P~E NUM8~ KAEEN TIEDE 248-3987 SANO ~KE SU~mVlS~ON 12: LOT ~2, BLOCK ~ , SITE P~N '' ,/ I / , ~ ~ i,/ t / / ,~/ I c<~.c SEPTic T~K TO / ~S/DI~ / . /~ ~OT 11, 8~K 1 / / ___/--- _ / ~~ /~ I~ 7/1/2ool KAREN TIEDE (907) 248-3987 1 OF 1 ~ ~&ff~/~. ~ ,ss: · ~"~"'~": ~?gi:':~...~ ..... ."~ SAND ~KE S/D ~2; LOT 12, BLOCK 1 ~ o~ ,o.~: SEPTIC SYSTEM UPGRADE: SITE P~N . ' JSOIL LOG - PERCO~TION TESTi ~'~v ~-':'"~ ~ OESCRIP~ON: ~O ~E SUBD"SION J2, LOT 12. BLOCK' {~.~.V ~7953 (feet)----.~] OR~ICS JTEST HOLE ~,~ I ,~T N ,1 ~.__~/~ ~' J . :::.:.~'::::':::: ' .... · spSW HHcH~ ~/''''", ~1 :~:~, DEPTH TO DATE '- 7-- :~.:~, GROUNDWATER ::;'::~, DATE RE. lNG CLOCK NET TIME WATER LEVEL NET DROP 11 -- ,,~:~ TIME (MIN~ES) RE. lNG (INCHES) ;:~::~ 6/5/2001 I 2:45 - 10" - 12- ;=j=:~ 2 2=ss lo VIE. o' 10' 13-- :~;.::~, 4 3:05 10 MIN. O' 10' ~4_ :~::~, 5 3:05 - ~o- - ::~:~' 6 3:15 10 MIN. O' 10' ~s- :~;.::~C 9 ~:20 - 6- - ~ 10 ~:24 4.5 UIN. O' 17~ I B.O~ 11 ~:24 - 6- - 18-- 12 ~:29 4.5 MIN. O" 6" I I 19-- PERCO~TION ~TE <1 (HIN./INCH) PERC. HOLE DIA. 6' .(INCHES) TEST R~ BETWEEN 7.5 FT. ~D 8.0 20--~ COHHENTS: PERFORMED BY ~ WATER & W~ATER I, JE~ A. C~NESS, CE~ T~T THIS ~ P~RFORMED IN ACCORD~CE W~ ~ ~ATE AND MUNIClP~ GUIDEUNES IN EF~CT ON THIS DA~: DEPTH TO DATE GROUNDWATER 0~r s/5/ol o~ G/x,t/o~ 08/24/01 12:54 FA~ 9072697650 D£C DW&WW [~002 oF EXVXRO IA SERVATXO DIVISION OF ENVIRONMENTAI~ DRINKING WATER and WAS~EWATER PROGRAM 555 CORDOVA STREET ANCIIORAGE, AK 99501 .http://w~w.~tate.ak.us/de¢/homefhtm Jeff'cry A. Gamess, P.E., M.S. Alaska Water & Wastewatcr Consultants, Inc. 6901 Dcbam Road, Suite 2-B Anchorage, ~laska 99504 Subject: Fax: (907) 269-7650 August 24, 2001 Lot 12, Block I, Sand Lake Subdivision, #2;Wastewatcr Disposal System Waiver Request from existing Class C Public Water System (PWSID Number 217940); Review Dear Mr. Ga'ness: This is response to your submittal received in this office on July 23, 2001in which you the Department to grant a separation distance waiver for thc wastewatcr disposal system intended to service a single family home on Lot 12, Block 1, Sand Lake Subdivision, #2. I have completed my review of the files on this property and thc information that you have submitted on this project. It appears that the submitted waiver request is reasonable. You requested that the Deparlmcnt waive the minimum horizontal separation between the Class C public water system source well serving four lots in this subdivision and the wastewater disposal system serving the single family home located on thc same piece of property [Lot 12, Block 1, Sand Lake Subdivision, #2]. As noted above, 1 have found that thc waiver is reasonable. Therefore, in accordance with the Drinking Water Regulations, the following waiver is being granted: Thc horizontal separation distance between the Class C public water system source well located on Lot 12, Block 1, Sand Lake Subdivision, #2 and thc wastcwatcr disposal system on Lot 12, Block I, Sand Lake Subdivision, #2, serving a single family home from i 50 feet to 100 feet. Thc above noted distance was taken from your submittal. If thc proposed wastewater disposal system fails · In addition, record drawings will need to be or needs to be upgraded, this waiver becomes invahd. submitted to verify that wastewater disposal system was located t'o meet thc above granted waiver. This waiver does not imply the granting of additional authorizations, nor obligate any local, state, or federal regulatory body to grant reqmred authonzatmn · Thank you f~)r your cooperation with this office. If you have any questions, please do not hesitate to contact mc. Environmental Engineer ACSE July ~'5, 2001 Karen Tlede 5135 W. 82'~ Avenue $~cnorage, Alaska 99502 ACS has no objection ~o the encroachment of ~he septic system into a platted easement located on Lot 12, Block 1, saadlake Subdivision # 2, k-~s depicted on the as-built drawing submitted. Acceptance and use of this letter of non-objection by yourself, your 'heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ~..~. ACS will be hel~ harmless, now and forever, or injury to any person or property as a result encroachment. 2. ~my ACS facility d~maged or desrzoyed as a resul~ encroachment will be repaired at Do cost ~o ACS. for any damages of thi~ this Any costs incurred by ACS for special consEruction ne,:e~sita~ed by ~his encroachmen~ will be borme by t~e property owner. 4. All applicable safe~¥ code cegulacions will De observed and maintained. 5. This letter of non-objection will in no way prGclude ACS from full use and enjoyment of its rights within an~ portion of its right-of-wa~. Sincerely, 4 ~ %e~'~side Plant Engineerin~ ACCEPTANCE: AC&P # 300 DATE :~ ~ £O0'd [~8~"U~ lO6:q~l£ 0£:$I (l~kt) lO,£O-'gh¥ ENCROACHMENT PERMIT 1204-10B G-2224 EN01046 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and Karcn V. Tiede of Anchorage (herein "Pennittce"), whose address is 5135 West g2"a Avenue, Anchorage, Alaska 99502. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities as follows: Described in that certain written instrument recorded on the 11s' day of March, 1952, in Book 69, Page 105, on file in thc office of the District Recorder, Anchorage Recording District, Seward Meridian, State of Alaska, Described in that certain written instrument recorded on the 14t~ day of April, 1952, in Book 70, Page 325, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, State of Alaska, (herein "Easement") which pertains to the following described real property: Thc East Ten Feet (E 10') of Lot Twelve (12), Block One (1), Sand Lake Subdivision No. 2, according to Plat Number P-176, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Twelve (12), Block One (1), Sand Lake Subdivision No. 2, according to Plat Number P-176, on file in the office 0fthe District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel"). 2. Encroachment. Pcrmittee has proposed to construct the following improvements on or within the real property subject to the Easement: A septic tank with cleanouts that encroaches approximately Five Feet (5') into the .Easement for a distance of approximately Eighteen Feet (I 8'), a septic drain field that encroaches approximately Three Feet (3') into the Easement for a distance of approximately Twenty-four Feet (24'), (herein "Encroachment"). Encroachment Permit - Page I of 4 3. Permit. Chugach hereby authorizes Permittee to construct and to continue the existence of the Encroachment in its current location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the construction or continuation ofthe Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes ofthe common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. $. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. c. Pcrmittee fails to make the payment described in paragraph 7, above. Encroachment Pen'nit - Page 2 of 4 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 1. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUOACH ELECTRIC~ By: ~.,~Z~'~'r/'~r~ / Title. Lee D.~i~ Executive M~ager, T & D Ne~ork Se~ices By: PERMITrEE Karen V. Tiede STATE OF ALASKA TIilRD JUDICIAL DISTRICT ~, The fo.r~going instrument was ackuowledg~d i~efore [ne this ~[,.3 day of /Z ° /A~t~g $'~':,2001,by ]...~ ~ "'ff~,~R"~ .the Executive Manager, T & D Network Services of Chugach Electric Association, Inc., an Alaska corporation, on behalfofthe corporation. Notary Public in and for the Slate of Alaska / ~a~e-~ My commission expires:__~'~" . ~ .. 4L~... Encroachment Permit - Page 3 of 4 STATE OF ALASKA ) ) THIRD JUDICIAL DISTRICT ) , . The foregoing instrument was ac ~kngwledged before me this q day of '-~,.~,.~,/ .2ooi, by Z'~~'' ~J~ary Public ~an.d~or the S~te of Alaska ~-d~y commission expires: AFrER RECORDING RETURN TO: Chugach Electric Association, Inc. Land Services Department P.O. Box 196300 Anchorage, Alaska 99519-6300 Encroachment Permit - i;age 4 of 4 Municipality of Anchorage Development Services Department Building Sa~ety Division On-Site Watcr and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK. www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WRY: WR010049 PID~: q11-132-37 HA#; Permil~: Date Received: 712/01 Legal Description: a k ! I Engineer:. Alaska Water and Westewater Consultants. Inc. 6901 Debart Rd.. Sutte 2B Anchoraae. AK 99504 Applicant: Karen Tlede Waiver Requested: 1 foot aeearatlon to lot line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: ~( Waiver is not Gmn~ed: LlstConditionsorReasonsforabove: ~<'*~'~ ~ A/ ~-" I/t/ E/~J~' ~ 5 /~'/~'/~E~ / -d/ Name of Reviewer Rec~: 66~:) Amount: }115.00 Date Paid: 712/01 STATE OF ALASKA 77440 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey f e" '''•N•�w° WATER WELL LOG Revised 08/18/2016 Drilling Started: / / Completed: 7 / 1 / 1955 Pump Install City/Borough Subdivision Block Lot Property Owner Name & Address Ira Schultz AK, Municipality of Anchorage Sand Lake Sub #2 1 12 Well location: Latitude 61.1472206 Longitude -149.973328 Meridian S Township 012N Range 004W Section 10 SW 1/4 of NW 1/4 of SE 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Drilling method: it rotary, ■ able tool,]Other Suggest T.M. Hanna's hydrogeologic classification system* https://my.ngwa.om/NC Prod uct?id=a 185000000BYub3AAD Well use:❑Public supplv,ODomestic, ❑Reinjection,❑Hydrofracking ❑Commercial,❑Observation/Monitoring,❑Test/Exploratory,❑Cooling, ®Irrigation/Agriculture,❑Grounding,❑Recharge/Aquifer Storage, []Heating, []Geothermal Exploration, []Other Fluids used: Depth From To Sand (reported) WL 70' 0 228 Hardpan 228 238 Depth of hole: 516 ft Casing stickup: ft Casing type: Casing thickness: inches Casing diameter: inches Casing depth: ft Gray clay, varies in consistency and mixing quality 238 476 Hardpan with gravel streaks. 476 516 Liner type: Depth: ft Diameter: inches Note: Well intake opening type: El Open end,Elopen hole, Other open hole Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, Perforated❑Yes 0 No Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packed❑YesONo Gravel start: ft, Gravel stop: ft Note: Static water (from top of casing): 80 ft on 7 / 1 /1955 Artesian well ❑ Pumping level & yield: 45 feet after 5 hours at 5 gpm Method of testing: Development method: Duration: Recovery rate: gpm Grout type: Volume Depth: From ft, To ft Include description or sketch of well location (include road names, buildings, etc.): Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion? Yes ■ No Method of disinfection: Was water quality tested?Wes nNo Water quality parameters tested: Welldriller name: .................................................................................. Company name: .P9TTEEN DRILLING ......................................................... Mailingaddress: .................................................................................... State: AK Zip: mber:AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that acopy of the well log be submitted to the Department of Naturalgnature: tAnchorage Resources within 45 days of well completion. Well logs maybe submitted using the online well log reporting system available at: Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City https://dnr.alaska.gov/welts/ within 30 days of well completion. OR email electronic well logs to City Permit Number: Date of Issue: —/—/ dnr.water. reports (ED alaska.gov Parcel Identification Number: `Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press ' - STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION C'ERTI~i~'I~, DEPi. CF H~AL~-i-I & for ENVIRONMENTAL p<,Z;'Frc~,fO ~ N PUBLIC WATER SYSTEMS I "" 1985 A. APPROVAL TO CONSTRUCT Plans for the construction or modification of in RECEIVED · public water system located ., Alaska, submitted in accordance with 18 AAC 80.100 have been reviewed and are FI.approved. : [] conditionally approved (see attached conditions). BY ' TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the ': ' ~ ? ~ ~ /' public water system was completed on ' ;- : . , (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY . TITLE ~ATE As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE DATE 18-0407 (Rev. 11/83) DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEEPJMUNI-BOROUGH (Complete Section C) 4. GOLOENROD - MUNI-BOROUGH (Complete. Section A) MUNICIPALITY OF ANCHORAGE a Development Services Department E Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-132-37 Legal description SAND LAKE #2 BLK 1 LT 12 Site address 5135 W 82ND AVE Current property owner(s) TROY & SUSAN BIERING Expiration Date:) 5 / C' 2 3 The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 6/29/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA Approval_June 2022 MUNIMPALIPITY OF ANCHORAGE Development Services Department - T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-132-37 Complete legal description SAND LAKE #2; BLOCK 1, LOT 12 Location (site address) 5135 WEST 82ND AVE *ANCHORAGE, AK Current property owner(s) TROY BIERING 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 907-244-8420 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units 0 Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑i Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: LL Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ I Waiver Fee $ Date of Payment Date of Payment COSA # 0 S C 'L3/1/6 Waiver # COSAApplication_June 2022 www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC231216 Subdivision: SAND LAKE #2, Block: 1, Lot: 12 A water sample revealed an arsenic concentration of 22.1 micrograms per liter (ug/L). 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.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P tO Box 196650 *Anchorage, Alaska 99519 6650 *www muni org Legal Description: SAND LAKE #2; BLOCK 1, LOT 12 Parcel ID: 011-132-37 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA SHARED WELL - LOCATED ON SAND LAKE #2; BLOCK 1, LOT 12 Q Well log is filed with Onsite (ora Well production at time of test N/A pm Date Date drilled 6/24/55 Total de h ft Water storage tank volume N/A gallons Cased to LINK ft �', 6 Well disinfected for coliform test? ❑ Yes No 0 Sanitary seal is functioning correctly 2 Q Coliform bacteria is Negative X Wires are properly protected ggn T Nitrate mg/L ❑Q Nitrate less than MRL (ND) Casing height (above ground) 12+ in. 1� q 123 Arsenic 22.1 ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA N/A Collected by GEG Static water level at beginning of test N/A ft. Date 3/28/2023 Comments H2O SAMPLE WAS PULLED AT SAND LAKE #2; BLOCK 2, LOT 13A B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank NEW ❑ Required maintenance copa Date of pumping N/A Age of lift station years ❑ Required maintenance completed, if AWWTS Lift statin erial Comments: menu - D. ABSORPTION FIELD DATA Which system tested (date installed) 6/19/2023 Q ALL standpipes present per record drawing Total measured depth from grade 12.5 ft (max) Measured depth to pipe invert from grade 5.37 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Adequacy test date NEW Results Q Pass Fluid depth prior to test in Water added - gal New fluid depth in Elapsed time - min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 0 in Effective depth remaining 72 in E. SEPARATION DISTANCES SHARED WELL - LOCATED ON SAND LAKE #2; BLOCK 1, LOT 12 From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Yes if No *80'+ ft Fm� Yes if No ft Neighboring Tank > 100' ❑n Yes if No ft Private Sewer/Septic Line > 25' RE Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *80'+ ft Holding Tank > 100' FC Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑■ Yes if No ft g Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑■ Yes if No ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' ❑o Yes if No ft Yes if No ** ft Q Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No ft ❑■ Yes if No ft Water Service Line > 10' M Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *OSV231009 - 80 FEET TO WELL ON SAND LAKE #2; BLOCK 1, LOT 12 **1'+ #SWO10340 FOR 2001 DRAINFIELD. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gayness Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Garness Phone 907-337-6179 Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 01 A x.:1.4 T:.......� .....�:�*. "u49 '• CE -795 rem •; LICEN E00aP fessi°r°c 41ECC884 �O�OOOo� L, Municipality of Anchorage Development Sentices Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-8650 v,~vw.d.n nchorege.ak.us (~07} :~-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A, SINGLE FAMILY DWELLING ParcelI.D. 011-132-37 ¶. GENERAL INFORMATION .../://'-7 o Expiration Date: /,~.- -~' ~,' o ~ Complete legal description SAND LAKE SUBDMSION ~q2; LOT 12, BLOCK 1, Locafior~(site address or directions) 5135 WEST 82ND AVENUE * ANCHORACE, AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KAREN T1EDE Dayphone 248-3987 5135 WEST 82ND AVENUE * ANCHORAGE, AK 99502 Day phone JOELLEN SMITH w/ WlLLEY BROOKS CO. Day phone 2525 BLUEBERRY ROAD * ANCHORAGE, AK 99503 258-5529 Unless otherwise requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: ,3 3. TYPE OF WATER SUPPLY: Individual Well B Individual Water Storage Community Class 'C' Well I Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer Tho Municlpality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the raprasentatlons given In paragraph 5 by an Independent professional civil engineer registered In the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewatar disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval ara valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certrtficatas 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 Munlcyality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. Note: Alaska Water and Westawatar Consallents, In= shall be paid $3,857.00 at, or pdor I to dosing for the engineering sen, ices provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I varify that my Invesb'geb'on, based on procedures ou#ined In the Health Authority Approval Guidelines for this applicab'on, shows that the on-si~e water supply and/or wastewatar disposal system is(are) safe, functional and adequate for the number of bedrooms and lype of structure Indicated herein. I further verify that based on the information obtained from the Munidpalib/ of Anchorage files and from my investigation and lnspection, the on-alia water supply and/or wastawater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect et ~e time of Installation. Name of Firm , ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD. SUrTE 2B * ANCHORAGE. AK 99504. Engineers Printed Name JE~I-I~EY A. C..,ARNESS, P.E. Engineer's Comments: In conducfing this evaluation, A WWC, Ino. edemptad to provide · conscJan~ous engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The repotted results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and sep#c systems depend on the local soils condition, groundwater levets that may. fluc~uets dudng the Jeer, and the water usage of ~he family being served by the system. These cond~'ona are outside the con~ol of the eveluator of ~he sjetem. Sati~actoq/ test results do not guarantee future performance of fl3e system, nor do ~hey guarantee that there ere no hidden dofec~ or encroachments. AWWC, Inc. can themtom not provide any wen~nty or future esffmata of how long the system will continue to meet the opere~al requirements of the ADEC or MOA DSD. The content of this report Is the sole benefit of the owuer tisfed above. Any reliance upon or use of thIs repo~t by any other pemon or party IS not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE ^p roved for Disapproved. CondiUonal approval for __ Phone 3,37-6179 Date Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: C~. ~ ~ _ o / Municipality of Anchorage Development Services Department Ol~,-Slte Water & Westewater Program 4700 South Oragaw St. p.o. Box 196~0 AAChOm~, AK g9519-~50 A. WELLDATA HEALTH AUTHORITY APPROVAL CHECKLIST SAND lAKE S/'D ~2; LOT 12, BLOCK 1, ParcellD: 011-152-;57 We, type Date completed Sanitary ~ (Y~ WATER ~,tPLE RESULTS: Date of pumping NEW C. ABSORPTION FIELD DATA Date of mample: 9,/14,/2001 Collected by:. 13. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL TankMze 10OO gal. Number of Compadmants 2 Dapressk3n over tank (Y/N) NO Pumper Date installed g/lO-11/2OOl 6ollreting(~o~)1.2 AWWC, INC. Oats Instated Ck~nou~ (Y~) High water alarm (Y/N) Length 27.5 lt. Width 2.0 + It. Toteldeplh*13.s-14.ofL Eff. al~onama 389 It* Monltorlngtube YES Date of adequacy te~t NEW Resul~ (Pass/Fall) PASS Water added gal. Any rejuvenation treatment (.east 12 mo.) (Y/N & type) 9,/10-11,/2001 N/^ System ~ DEEP TRENCH Gravel below pipe 7.O7 fL Depresalon over'riehl NO Fo~ 3 bedrooms New deplh In. Ab~on ra~ >~ g.p.d. ff yes. give date D. UFT STATION Date .~__~, ed Size In gallons ~ 'Pump on level at In. 'Pum n. Hlgh water alarm level at In. ~ Cycles tested Meets alarm & circuit requlmmente? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *ADEC WANER ISSUED e'MOA WANER ISSUED On adjacent lots, *.110'+ On adjacent Iota. **12o'+ Publlo eewet i11arthote~cteartout N/A Holdlrtg tank N/A Septic tenk/llft ~tetion on let, .100'+ Ab~otl:)Uon field off lot, .100'+ Publlc sewer main N/A Sewer/~eptic ~ervlce line 25'+ Abeeq~on tield Surface water. 100'+ **LOT UNE WANER ISSUED Water main N/A .Driveway, pe~dngNehlcle atorage, 5'+ Cutteln drain NONE KNOWN F. COMMENTS SEPARATION DISTANCES FROM SEF11C/HOLDING TANK ON LOT TO: Bulldlng foundation 5'+ Property Ilne 5' Water main N,/A Water setldce lille lO'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: F~opetty line *'1'+ Building foundaUon 10'+ Water aen~ce line ~ o'+ Surface water lOO'+ Wells on adjacent lots 100'+ G. ENGINEERS CERTIFICATION I certify that I have determined through field inspec6~ns and review of Municipal mcord~ that ~he above aT.ems em In conformance with MOA HA4 guidelines in effect on this date. EnglneerelWlnted~lame/ JEFFe~ A. O~NESS H/La. Fee $ ~00. oo Receipt Number 0 Waiver Fee $ Date of Payment Receipt Number ~.,.~TER M~CHORAGE A:;EA SC:tOUGH / -F - Department of Environ:;entai Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ,~ ~,'~ :~" Time of Inspection Date of Inspection Approval requested by: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Property Owner: ~ Phone: Mailing Address: Legal Description: / Type of facility to be inspected No. of bedrooms C. Construction D. Bacterial Analysis Sewage Disposal System: ~ A. Installed ~//~¢~/. ~ B. Installer 2. Manufacturer C. Septic Tank: 1. Size 2. Material D. Seepage Pit: 1. Absorption Area E. Disposal' Field: Total length of lines Distances. A. Well to: Septic tank Nearest lot line B: Foundation to septic tank C. Absorption area to nearest lot line , Absorption area , Other contamination , Absorption area· Sewer Lines · : Page I of two pages l GREATER ANCHORAGE AREA BOROUGH._i Department of Environmental Quality 3330 "C" St., AnChorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA FHA Property Owner: Mai-ling Address: Name of Buyer: Mailing Address': Name of Lending Institution: Ma'iling Address: CONV .S-/~- Pc/ ~ ~z~d~/z~1'~/~'' 'Oa.y Phone. ~ F~l~,~'/ ~,Y~ Day Phone Phone 5. Name of Realtor or.Agent: ~-~-~ Mailing Address: Phone Legal Description: Location: S-~ 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility No. Bdrms .~r~'~;,~.~_o._~ Individual ~/' If Individual, number of dwellings presently served If Individual, depth of well .~<--/~, ~f~-~ Sewage Disposa] System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (}/74) October 1I, !974 Hfs, Karen Tiede 5135 ~l..~2nd Avenue Anchorage, Alaska SUBJECT: Semipublic ~ell On Lot lg, B)ock 1, Sand Lake Subdivision ~ear ~s. T~e~e: The Well on the subject properILv cannot be approved a: thts time, .approval can be grantedyoumust do ~he following: 1, ~aise the ~ell casing t~elve (1~) Inches above ground level, Fill in the pt~ the well is in. it should be fHled in ~tth impervious soH ~fth ground level sloph~§ a~ay fro~ ~he casing. Xf the Hope of the land is enough, a daylight drain could be put tn. This ~oul~ mean you ~ould have to tns~a11 a drain in :he' floor of the ~ell house. ~se piping :hen ~ou~d need'to drain out rite side of a hill or Hope. Tl~e pipe should be :uo {~} inches tn diameter-and should be screened at the outlet. Xf you have any further questions regarding this matter, please contact me at 274-4~6t, extension 137. Sincerely, Robert C. Pratt £nvir~q~ntal Control Officer III RCP/Iw October 14, 1974 Karen Ttede 5135 ~l~st 8grid Avenue Anchorages Alaska ~950~ SUI~IECT: Sewer and facilities serving Lot 12., Block 1. Sand Lake Subd, ~2 Dear~es. T~ede: The sewer facilities servtng the subject lot are approved. The ~ell =eh:toned tn the letter to you of October 1~, 1974, ts not approved and cannot be approved untt1 the dlscrepanctes mentioned tn that letter a~e corrected, Sincerely, Robert C. Pratt, ~nvtron~en:al Control Officer III RCPtko 2. 3. 4. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) l~an~ of property owner Number ~f bedrooms in house Water Analysis: a. Bacteria] b. Detemgent Well data: a, b. c0 d. Casing Size ~'~' Distance from well to closest existing or proposed: 1. Sewer line -,~ 2. Septic tank Seepage Area 4. Cesspool.' ~, / 5. Property Line..~; . 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system. a. Age of system !~ ~ b. Septic tank capacity in gallons c. Name of septic tank manufactu~Dr If "home made" show diagram on reverse side of this form. Disposal field or seepage pit size and type 1. Distance tO property line. /,~' , to house foundation e. Percolation. Test results f. Percolation Test performed by Use the reverse tide of this form to show ~ agram. Diagram should include the foito,,~ing info~r,ation: ppoperty lines~.well location, house location, n-~p~ic tank location: 61sposal area location~ location of percolation test, and direction cf ground slope, The [xtfo~mation on tkis form is true and correct to the best of my knowledge. ~gnature of Applicant Date Signed TO BE FILLED OUT %Y HEALTH DEPART~4ENT PERSONNEL above described sanitary facilities are hereby approved, subject to the ~'llowing conditions: The above described sanitary facilities are disapproved for the following ~easons% Appx'o',~l'is valid for one year following the date of approval. CPJ: cw June 8, 1967 Mr. Cliff Judkins Greater Anchorage Area Borough Health Department Anchorage, Alaska Septic Tank Location Lot 12 Block 1 Sand Lake Sub. #2 Dear 01iff: At your suggestion, we took tie-do~nmeasurements on the location of~he 1000 gallon septic tank installed on our premises at Lot 12 Block 1 Sand Lake Sub. #2 in May of this year (5135 82ndAvenue). We measured the distance to each ~-hole from the north and south corners of the carport. North corner carport to Manhole 1 ." South comer carport to Manhole 1 ,* North corner carport to Manhole 2= South corner carport to Manhole 2: Please see sketch. 21.5 feet 17.0 feet 25.5 feet 23.0 feet I hope this is sufficient information for your files. Sincerely, Karen V. Tiede (Mrs. William J. Tiede, Jr.) ..[~i ~ ,~Uh~ 12 t9§? -~ GF~E',IER ANCHORAGE A~EA '~,OROUGH - HF-AL1-H D ~PARI'M~N,[, ~ay 2~ t967 Mr. William Tiede~ Jr, 5135 82nd Avenue Anchorage, Alaska "~ ~ i' · '~e Disposal Facilities DL 153-731-A~A Dear ar. Tiede: m~cn ...... ~,e Aras.: Bo~-ough Health Department inspscted the ,~uhject facilities on May 2~ 1967, The facilities w~re found to be in ccmplianc~ ~ '~ ~ ~.~ ~o~a.~. o~dinances and codas and are hereby approved, ?fhe ,,3vst~n con,.i.~l of a lO00-gallon septic tank, (liquid eapacity)~ Sincerely DAVID R, L. DUNCAN, ~eaical Dzrector C~ J/~,rr cc: Veterans Administration BY: Clifford P. Judkins, Il. S. Chisf Sanit abiau t~ay 2g~ t967 Seattle, Washingl:om 98121 SU~JECT: Sewage Disposal Facilities Lot 1~, Block 1~ Sandlake ~2 DL 153-731-AAA Dear $ir~ Tile Gr~ate~ Anchorage Area Borough Health Department inspected the subject facilities on May 22, 19~7. The faollttxe were found to be in compliance with local o~dtnanaes and codes and a~e hereby apppoved. ' d The system ~onsists of a lO00-gallcn sep~le tank, (l[qu~ capacity), and an adequately st~e~ seepage system. Stnce~'e ly, DAVID R. L. DUNCAN, !4. D. ~edtcal Director Cliffomd P. Judkfns~ R. $. Chief Sanitarian William Tiede, Jr. 49 TH* J V O a SHANE A. HOLT LS -6914 Q�aA '�'°fessioW L O O W O O i cv iy �sn.� nnry i�vnr1 WEST 82 ND AVENUE EL EC EASEMENT AFFECT S THE S 5'A NO THE EAST IO' RECORDED AT BOOK 1251, PAGE 870 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON C UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS• ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE 1 ^ = 20 FENCE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY -OTI2BLOCKI SANDLAKENO2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 23RD DAY OF JOVE , 2023 15727 228-14 232-24 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 907-223-8615 f STATE OF ALASKA 77440 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Drilling Started: (_ / Completed: 7 / 1 ( 1955 Pump Install: 1 / Cit /Boron hSubdivision Block Lot Property Owner Name & Address Ira Schultz A K, Municipality of Anchorage Sand Lake Sub #2 1 12 Well location: Latitude 61.1472206 Longitude -149.973328 Meridian S Township 012N Range 004W Section 10 1 SW 1/4 of NW 1/4 of SE 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Drilling method: it rotary, able tool[Other Suggest T.M. Hanna's hydrogeologic classification system* https:Hmy.ngwa.org/NC Product?id=a185000000I3Yub3AAD Well use:[]Public supply, Domestic, []Reinjection,[]Hydrofracking Commercial,[]Observation/Monitoring, []Test/Exploratory,OCooling, Irrigation/Agriculture,rounding,ORecharge/Aquifer Storage, []Heating, []Geothermal Exploration,[]Other Fluids used: Depth From To Sand (reported) WL 70' 0 1228 Hardpan 228 238 Gray clay, varies in consistency and mixing quality 238 476 Depth of hole: 516 ft Casing stickup: ft Casing type: Casing thickness: inches Casing diameter: inches Casing depth: ft Hardpan with gravel streaks. 476 516 Liner type: Depth: ft Diameter: inches Note: Well intake opening type: 0 Open end, ■ pen hole, Other open hole Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, Perforated[3Yes r-1 No Perforation description: Perffrom: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packed0Yes [9No Gravel start: ft , Gravel stop: ft Note: Static water (from top of casing): 80 it on 7 / 1 /1955 Artesian well Pumping level & yield: 45 feet after 5 hours at 5 gpm Method of testing: Development method: Duration: Recovery rate: gpm Grout type: Volume Depth: From ft, To ft Include description or sketch of well location (inc ude road names, buildings, etc.): Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion? 0 Yes ■ No Method of disinfection: Was water quality tested. ess No Water quality parameters tested: Well driller name: .................................................................................. Company name: DOTTEN DRILLING ............................................I ......... ... Mailingaddress: ................... ........................................ ....................... City: State: AK Zip: Phone number; �) AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Drillers signature: Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: Date: / Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City https://dn r. a laska. qov/welts/ within 30 days of well completion. OR email electronic well logs to Gity Permit Number: Date of Issue: ! / dnr.water.reports(u)alaska.gov Parcel Identification Number: 'Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press WAD Exp. (GW) April 1966 Well' no. WELL SCHEDULE U. S. DEPT, Olr TliE INTERIOR GEOLOGICAL SURVEY WATER RESOURCES DIVISION MASTER CARD Record bySour a J I of d ta -Z- � Date State 'A�- County 11 _= '-4' ,,, e 2 Latitude: I ES Longitude: Sequential / 9 7 m -n. 9 sec 12 1 To n sec To 19 accuracy: +12 agree I To� n E agrees 20 T S, R Local Set B & well —number: [7, '0 1 '. ! I I (' 11 Other Local use: Owner or name: 'At , Q Address - 56 �.i " �W' = D Ownership: co (C) ( (N Unty, Fed City, Corp or) Co'ZrV_aState(ASg)ancy, Wate(W) sal.) r Dist Mp (A) (3) (C) (D) (E) (F) r6i"-")(') (M) (?;) (p) (S) Use of Air cond, Bottling, C01mm, Dawater, Power, Fira,t water: _RTjIrr, Had, Ind, P S, Re,, ($) (I) (U) (V) (W) (X) (Y) (S) Stock, Instit, Unused, Repressure, Recharge, Desal-P S, Deaal-other, Other 6D1171 Use of (A) (D) (G) (H) M (p) well: Anode, Drair., Seismic, Heat Res, Obs, Oil -gas, Recharge, Test, unased,(_Witi�r 69 Destroyed ED DATA AVAILABLE- Well data 70 Freq. W/L mass.: F-1 Field aquifer char. 72F_1 g2d. lab. data: 73F I _Qual. water data; type: er"M PC t A r 74 0z %'`t 4, F El Freq, sampling! yes ED Pumpage inventory. no, period: 76i 1 is -Aperture cards: yes 77 Log data:z-,; 6;:� WEL L-DESCRIP TION CARD To 79 SAME ONMASTER _57i Depth well, TV I'g, r" Depth cased:accuracy (first part --)ft 4' Casind 30 Z3 2ft type: Diam. 1� in (C' (S) 2 30 Finish: porous gra w. Z --R-1 III. h.(rl.. Spe)n p(pr)f., screen, so. pt., shored Lpi concrete, (perf.) A grave gallery, end, gell'i/ Method (A) (S) /(C) �) (D) (H) (J) 0 or. h- : i dug, (P) (R) (I) BMI,d d (V) (W) r hyd jetted, ir.,,,, reverse trenching, driven, drive 0" rot., M�; .4 Date percussion, rotary, wash,es 3.2 ijj Zum intake setting:, t 33 35 Driller: 64 -Ll= E)LI T-1,FA/ 36 36— Lift xrame (A), b.&B) (C) (j), "'l(L) (M) apress Deep air, et, cent, jet (ttiple, multigle. (N) (P) (R) (S) (T) (3) e, (cent.) (tur .) none, piston, rot, submarg, turb, other F7 Sha low Power net LP 39 diesel, ale gasoline, hand, gas, wind; Hp. luas_-or Q meter no. above _t below LSD . Alt. MP Ac Alt. LSD: 'c ura"y 43 M. fil 4 Water above 42 a Level '= LSD �ft below MP, Ft:1, l::a__) E Accuracy: Date 41 --Yl - 53 47 h I Yield: stom I i �' 6 determined ITT Drawdown: Pumping _17 Accuracy. period 64 EE hrg 2MI—TV0F 63 6 WATER Irons / F, jSulfate Chloride. Hard. PFm F4. PPM 70 — 6DQE' Ppm 71 72 §j..Conduct QL,5 Cj K x 10 DPPM Dam lad 9 ' '5' 1 73 74 76 7 79 Taste, color, etc. eT5440R -- (, V# - -7 Xg'- Latitude -longitude r S LD 6 d m a d Is H Y D ROGEOLOGIC CARD or- T Phyi.graphic SAME AS ON ER CARD Province: P'Cj FIC. Province:S Section: 19 !B rai ag E -,%1, 0 V 141 Ba40�-Oj Subbasin: ;3 2A (D) (C) (E) (F) (R) (K) (L) Topo of depression, stream channel, dunes, flat, hilltop, sink, swamp, well of (4) M (S) (T) 0) M offshore, pediment, hillside, terrace.(undnlat ng, valley flat L"'� 'L'JOR- QUA-, AQUIFER, —2LE 127 0 system sere;- - 28 29 aquifer, formation, group 30 Aquifer Lithology: Q- Origin: GL-A.cjr, Lt FFlThickness- ft Length of34 Depth to well open to: ft top of: ft 35 37 oi .,J UMIF .• =-1 system series aqui ar, ormation -group uil.r Litholo Origin: MTbickness: 46 A7 -ft Length of Depthso to 5well open to: ft EU of: ft 1 S3 1 ..ntervals 57 9 Screened - IM h to cao. li ted rack.. Et e0 i i Source of data: 641:1 Depth to basement: ft i Source of data: 69= Surficial Infiltration material- characteristics: 72 Coefficient Coefficient 0 Storage; I L 1 gpd/ft 73 75 76 76 Coefficient 2 Perm- _Spd/ft ; Spec cap- /ft; Number of geologic cards: _0 79 LOG: 0-2281 - Sand (reported) WL 701 228-238 - Hardpan ' 238-476 - Gray clay, varies in consistancy & mixing quality 476-516 - Hardpan with gravel streaks Drilling quite hard. Well finished in gravel streak. Was very dirty at first but responded to bailing EMARKS: Deepest domestic well. When developing drawdown was 151 at 1001, water level came up to 801 the following day. )CATION: 1001 north of access road 0.18? miles east of Sand Lake Road 0.37 mile south of Kincaid Road GF10 857-7W I A ZT,