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Home My WebLink AboutMULBERRY TR A1Mulberry Tract A-! #018-232-29 Municipality of Anchorage Department of Health and Human Services Div~slo~ o~ Envtronmefltal Services ' Oo-Site Sendces Sec~on 825'1.' Street Room 502 P.O. 6o~ lS6650 Anct~'age, N< 995196650 Page of v, ww,d,ancflomge.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~OOOOt~ PID Number:. ,.~+eVC [~'~r, t4t{~ 4 Ka,'e,-t ~ro~'n. WastewaterSystem: [~,ew I-IUpgrade SEPARATION DISTANCES I~ sep,c D I~d~.o 13 S.TZ.P. n N~ Ic~ BENCH MARK /o~ .................. AS-BUILT SYSTEM DETAILS/SITE PLAN Per,~i* svoooo4e MULBERRY S/D, TRACT A-I PID#Ole-232-29 "'I , " ......................... T~ - -~-g G---~ ................................................ i i CO ~ I ' '~' ' 4 i , i i ' ~ SCAL[, 1' = 50' I~T B-D:64.8' a ~ C-D=74.8' ~ ~ ~ m~ B-E=67.8' ~ ~nn ~'.~ FINIZH~D,GRADE B-F:39.3' q ~laSo GA'~~m~Ukm F ~'= B-G:94.1' . / I TANK I ~ I S~V~R ROCK ~-~:,o~.~. ~ ~1 ~ I ~ I ~ .. PREPARED FDR: SCALD NTS s,~ CASTALOl ~ KMO 20441 PTARMIGAN BLVD. ~'~SStO~'~ CASTALDI ~/4/g~ EAGLE RIVER, AK 99577-8736 ~~ ~ ~ ~ 2~6 [I ~98070.DW0 ~: 98070 (907)698-Stli~F~ (907)698-atlt MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Renewal Date Issued: Apr 06, 2000 Expiration Date: Apr 06, 2001 Permit Number: SW000048 Legal Description: MULBERRYTR A1 Design Engineer: 0070 KND Engineering Owner Name: Steve Miranda & Karen Brown Owner Address: 3650 McMahon Ave. Anchorage. AK 99516-2872 ParcellD: 018-232-29 Site Address: 004601 135TH AVE E Lot Size: 98881 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage construction must be in accordance with: 1. The attached approved design. 2. mi 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15. a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: ~/'-- 7~ ~ Date: ~ - 7-00 Mtmicipality of Anchorage Department of Health and Human Services 825 'L" Street Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http:l/www.ci.anchorage.ak.us December 30, 1999 BROWN KAREN 3650 MCMAHON AVENUE ANCHORAGE, AK 995162872 Subject: MULBERRY TR Al Permit # SW990050 PID # 1823229 The subject permit #SW990050 issued by this office for a single family well and/or on- site wastewater system, is due to expire 365 days after it's issuance on 05-Apr-99. If this is a well permit and you have drilled the well, a well log must be sent to this office for documentation ofthe installation and to close the permit. If this is an on-site wastewater system and a licensed Professional Engineer has inspected the installation, the original as-built inspection report must be sent to this office for review, approval and documentation. Ail inspection reports must be submitted within 30 days of construction completion. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. However a new permit can be issued free of charge for a second year if the application for the renewal is received on or before the date of expiration of the original permit for which a fee was paid. When applying for a new permit after the original permit has expired or for more than a second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 343-4744. Jam~ Cross, PE Program Manager On-site Services enc: Copy of Permit MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street. Room 502 P.O. Box 196650, Anchorage. AK 99519-6650 (907) 343-4744 ON. SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Apr 05, 1999 Expiration Date: Apr 04, 2000 Permit Number: SW990050 · Legal Description: MULBERRY TR A1 Design Engineer:. 0070 KND Engineering Owner Name: Steve Miranda & Kamn Brown OwnerAddress: 3650 MCMAHON AVENUE ANCHORAGE, AK 99516-2872 Parcel ID: 018-232-29 Site Address: 004601 135TH AVE E Lot Size: 98881 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. 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 engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either:. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. At time of construction the engineer shall verify that no other wastewater disposal system exists on the lot. ,,,. - K~Xx~D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8?36 (907)696-61 ll/FAX (907)696-8111 March 6, 1999 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: New sewer permit - Mulben'y S/D, Tract A-1 Gentlemen: The owner has requested we proceed forward to obtain a new septic permit on the subject lot. On May 16, 1998 we dug one testhole for the proposed system. The results of these tests are attached. The general slope of this lot is from northeast to southwest at approximately 2% - 5%. We have designed our system utilizing the testhole we excavated for the four-bedroom house, which is proposed for this lot. The lot will be served by the existing individual well as indicated on the drawing. We propose to install a 2' wide deep trench. A layer of silty material was encountered during the excavation, which we have discounted in the calculation for effective area. We are placing 7 feet of gravel with using only a 5.5' effective depth. Water was not encountered during the excavation or monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~[~ I'~:[ ;,D Engineering -- ~(-~-~neth M. Du~ attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test /ELL/V/ASTEV/ATER DISPOSAL MULBERRY SYSTEM DETAILS/SITE TRACT A-1 " .'" i $£PTZC i PLAN TH K 8 LOT 5 LOT $ A-! venue ]~SIGN DETAILS 4 B'nRH X 150 GPD= 600 GPD 600 GPII/0.8 GPI) PER SQ. FT. (12 NIN/IN.)-- 750 SQ. FT 750/(2'(~/) X 5.5' (1)) (7' GRAVEL/5.5' EFF.) = 68.18 FT. TRENCH USE I TRENCH - 68.5'(L) X 2' (~/) X 7'(D) Totoi depth OF system Is 10.0' Fpon orlgln~l grode, To~L depth oF grmvel below distribution pipe Is 7,0' (5.5' EFF). NOTES, ~. CONTRACTOR TD INSTALL 1Z30 GALLON SEPTIC TANK, INSULATE TANK IF <4' COVER, ~. INSULATE TRENCH ~[TH ~' HD 9URIAL FOAM IF LESS THAN 3' COVER. CONTRACTOR ~[LL ENSURE HAX]HUH 2X SLOPE INTO SEPTIC TANK. CONTRACTOR ~ILL ENSURE ALL SEPARATIONS TO ADJACENT ~ELLS [ SEPTICS. STEVE HIRANZ)A & KAREN BRO~/N u~^~: KMI~ 2/25/99 · 2936 :3650 McMAHON ANCHORAGE, AK 99516 FIELD BOOKS eO~JnO~.qY: CASTALOI ST~X..¢: CASTALOI ^SeV~Lt: CASTALDI ^cAD n~: 98070.DWC Sc~Lex 1'= 100' PAGE 1 DF ;2 ]-~.) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ,,ce N~.: 98070 (007)696--61 I I/FAX (907)696-8 ! 11 WASTEWATER DISPBSAL SYSTEM MULBERRY S/I), TRACT A-1 DETAILS K D 9 SY BSED PRIHAF la50 GAL, S, PREPARE]) FOR, STEVE MIRANDA & KAREN DRDWN 3650 HcMAHDN ANCHDRA6Eo AK 99516 ~^~": KMD D^m 2,/2,/25 o~,o: 2936 98070 Scare: 1'= 20' PAGE 2 DF 2 i.~ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-§736 (907)696-6111/FAX (907)696-8111 ]~ND £NGINEER|NG 20441 I~FAR~GAN BLVD. EAGLE RIVER~ AK 99S77-8736 Performed for: SOILS PERCOLATION TEST Steve Miranda Project: Mulberry Tr. A-1 TEST HOLE # 96-2 SEE ATTACHED SITE PLAN FOR HOLE LOC. ATION GI'/SP J WasCmund waterencounteved? NO What depth? MA Depth to water after monitoring? DRY Date? 5/30/98 4- 5- 6--- 7o 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- ME/GM- varies in color And thickness B.O.IL Reading Date Gro~s Net Depth to Net Time Time Water Drop 1 5/18/98 2:45 7" 2 2:55 10 mln 6 1/4" 3/4" 3 * 2'.,56 7" 4 3.-06 10 mtn 6 3/8" S/8' 5 * 3.-07 7" 6 3:17 lO min 6 3/8" 5/8" 7 * 3:27 7' 8 3:28 10 mtn 6 1/4" 3/4" 9 * 3:29 7" - 10 3:39 10 mln 6 1/4" 3/4" 11 * 3:40 7" . 12 3:50 10 rain 6 1/4" 3/4" · Water Added 19- I Percolation Rate 12 (min/in)PercHoleDiameh.w__ 20- I Test Run Between ~ feet and 4 feet I, Kenneth M. Duffus, certify that this test was [xn'formed in accordance with all State and Municipal guidelines in effc~--t on this date. Municipality of Anchorage Development Services Department ' Building Safety Division ' On-Site Water and Wastewater Program 4700.South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us - - · (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell. D. 01B-232-29 GENERAL INFORMATION Complete legal description HAA# HP, Expiration Date: Mulber~ SID. Tract Location (site address or;directions) OIC~I~O 4601 E. 125 Ave.: Anchorage~ AK 99516 Current Property owner(s) St~,ve Mlranda/Karen Brown Dayphone 346-7~;38 Mailing address Lending agency 3650 McMahom Anchorage; AK 99616 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results less than 30 days old. (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 r the, vahdabon date .shown: below, I 'verify, that, my'~ nvestigation ha§ed on ' procedures·:outlined . in .the '., Health ,.Auth0rity ~ Al~proval ' Guidelines'. for ,' this', application, shows that the on-site water supply ~;nd/~r~waste~ater,disp(~sal system s(are) safe,: functiona ~, · and adequate .for the number of ,bedrooms and ,type 'of~structure .indica!ed.'herein. I.further verify',that~ based on the information obtained from the Municipality' of Anchorage flies.and fromlmy investigation add inspection, the on-ste water supply and/or, wastewater disp6sal system is(are} in!compliance with·'all, applicable Municipal and State codes, ordinances, and regulations in effect at the time of installati6n. Name of Firm KND Enaineerina - ~hone .: 69~-6111 Address 20441 Ptnrmlgan Blvd.: E.R.: AK 99577 Engineer's Printed Name Kenneth M. Duffus DSD SIGNATURE Approved for L~ Disapproved. Conditional approval for bedrooms. Date 041o31ol . - · · %?,;?,, ..,, __ 'bedrooms, with the following stipulations: .. ~ ~'.. ..... ...,.,~ _.._ . -. Additional Comments ~"-~"'. WATERAND: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Legal Description: WELL DATA Well type ~rlvste Municipality of Anchorage Development Services Department 8ulldlng Safety DNIslon On-~lta Water & Wastewater Program 4700 South 8ragaw St. P.O. Box 196650 Anchorage, AK g9519-6650 ~vw.ct.anchorage.ak. us (907) 343-7{)04 HEALTH AUTHORITY APPROVAL CHECKLIST Mulberry Tract A~I If A, B, or C provide PWSID ~ Date complete~ Sanitary seal (Y/N) y Total depth 147 fl. Cased to 147 ft. FROM WELL LOG Data of test ~ Static water level I 0 0 ft. Well production 1 § g.p.m WATER SAMPLE RESULTS: Parcel ID: 018-232-29 Total depth t0 ft. Eft. absorption area 850 ~ Monitoring tube Y Date of adequacy test HA - Flew System Fluid depth in absorption field before test __ Elapsed Time: ~ min. Final fluid depth Any rejuvenation trealment (past 12 mo.) (Y/N & type) Depression over field N Results (Pass/Fail) For bedrooms in. Water added.__ gal. Now depth in. in. Absorption rate >= g.p.d. If yes, give date Soil rating (g.p.d./ft~ or~/bdrm) 0.8 Systemtype Trench lt. Width ~ ft. Gravel below pipe 7.2 6 Data of pumping C. ABSORPTION FIELD DATA Date installed 05/06/99 Length 77,5 Pumper Coliform 0 colonies/100 mi. Nitrate_l~,a~jng.ll. Date of sample: 03/27/01 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material 8teal Date InstallS__ Tank size _.12,~L_gal. Cleanouta .y._Foundation cleanout .y.._Depresslon over tank N High water alarm NA Number of Compartments Offier bacteria 0 coloniesll00ml KND En_alneerlna Well Log (Y/N) y . Wires properly protected (Y/N) y Casing height (above ground) 1 ~1 ' AT INSPECTION 122 ff. ~i t' g.p.m. D. UFT STATION Date installed NA 'Pump on' level at Size in gallons in. 'Pump of~ level at Datum. Cycles tasted SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot 100'+ Absorption field on lot 1OO'+ Public sewer main 7[;'+ Sewer/septic service line 25'+ Property line 10'+ Water Service line 10'+ Curtain drain EO'+ F. COMMENTS Manhole/Access (Y/N), in. High watar alarm level at Meets alarm & circuit requirements?. in. On adjacent lots I 0 0 ' + On adjacent lots I <) O' '~ Public sewer manhole/cleanout Holding tank 1 0 0 ' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation [;'+ Property line [; ' + Absorption field [; ' ~- Watarmaln 10'+ Watersewlcellne 10'+ Suffacewater 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation I 0 ' + Water main 1 Q ' + Surface watar 1 0 0 ' + Driveway. parldng/vehlc~e storage 2 6 ' + Wells on adjacent lots I 0 0' + G. ENGINEER'S CERTIFICATION _~'"a..- ,m~, ) , ce,.. .ye m~ew of Muni~pe/ m~s ~at ~e a~ s~ em/n ~~,~. · ~ Engln~es Pdn~d Name Kenneth M. D~us ~I~%. ..~ Date 0410312001 ~?RO~a~ Data of Payment Z///O3/~ [ R,ce pt Number Waiver Fee $ Data of Payment Receipt Number 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 April 6, 2001 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Mulberry S/D, Tract A-1 (Permit SW000048) Gentlemen: Per your request, the subject property has not been inhabited since the construction of the on-site septic system in May of 1999. The owners are just now completing construction, and are planning to move into the house within the next few weeks. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ]]~1'{ '~) Engineering Brent M. Western 04-OZ-OI 15:51 FROV,-CTE ENVIRONt, ENTAL 5615301 T-016 P.OZ/03 F-904 ~l~r~m. CT&E Emlmnmental ~lces Inc. CT&£ Ref, a 1011490001 Client Name K'~D Engb~ect"in§ Prolect Name/ff MulbcHY Txact A-1 Client Sample ID Mulberry 'l%act A-1 Matrix Drinking Water Ordered By ~ PWSID 0 Sample R~mar~: P.~ulls Nirratc-.N 113 Client PO# Printed 13ate/Time 04/02/2001 8:34 Cellected 13ate/Time 03/27/2001 11:30 Received Date/I'lme 03/27/2001 15:00 Technical 13irector Stephen C. £de Released By ~~,. PQL Allowable p~p .~alysls Method Limita I~le Date ]rlit 0.500 mg/L EPA 300.0 I 0 max 03/27/01 SCL Microbiology Laborat:o:¥ Total Coliform col/lOOml. SMI8 922213 03/27/01 SKW 04-02-01 15:51 FR0~'CTE ENVIRffiI~NTAL 5515301 T-016 P.03/03 F-904 CT&E Environmental Services Inc. I.sboratory Division ~;~~r~,~,~,,~,w,~,~,~'~',~'~'~'~ 200 W. Po~er Drive Teh I907) 562-2343 )rinking Water Analysis Report for Total Coliform Bacteria A,ohorag,. AK g~S~e-~6OS MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY A,~alysis shows this Water SAMPLE to be: o pC.UCWATERSVSTEML".# 11 I I I I '1 ~ Sa,isl.=tory WATER SYSTEM Se~ la.ice Send Resuhs Send Invoice SAMPLE DATE: Month SAMPLE TYPE: ~ Repeat Sample (for routine sample wit# lab ref. no. _ = ) ~ Spe~tal Purpose SAMPLE LOCATION Year n TrentedWater 12 Untreated Water Time Collected Coil*clod By D Unsatisfactory n Sample over 30 hourS old, results may be unreliable Sample too long in transit~ sample should not be ove~g}hours old at examination to indicate ~liable results. Please send new sample via special delivery mail. Dat. Rec.l¥~ Time Received J ~'~ A,al~sls nega. AnalytleM ~ethod: ~Mcmbrane Filt~ v~ ~MMO-MUO * N,,..~- 10 mi. Result* Analyst .. ~.U.F,.C. Anch Fbks J~n fazed Date: _ 'rime: Client notified of unsatisfactory results: Phoned Spoke with Faxed Dsm: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG ResMt: Total Coliform Membrane Filter: Direct Count Verification: LTB BGB Fecal Coliform Confirmation Final Membrane Filter Results £. Coti .. Colonlestl00 mi COLIFIRM Coliform/tOO mi Time ~/~-'~ hfs iIl~ E~E~ Membor of the SGG Group (Soci~til G6n&rale ae Su~'eillance) ENVIRONMENTAL FACILITIE~ iN ALASKA, CAUFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA i'::' J': i,i]tvi ]L 'i' I',i;i.i'.,l~.i"li. lr'l 13,;ISS'tRI'.iC:I:::' t:iJi£'t'I4EI:EN R ,~,.IEI..L i:il'4['..', RI'-,IY Oi",l-~-SI'l'E ':2;ENI::IGE D',]:SSI:::'OC':i;f:It-,. S.:.;'.,.'E.:;Tf::;I'"I ];:!~:; ;]..i.~ji;i:.l I.::Eb;I l..:'Llt;~'. I-::I F:'R':I:VRTb: t.,JELL. Ot4: 2(:l~;i.~ I-:.-IF::.;E'I* I:-'OI:~:'. R F'L.IBL. :[ C: I.,.IEI.~I .... (..il.:; 'IJ'"IE; 1.4E~L.I.. E:CihlI.:*L.E'I" );. Ol'-,I. ~:i,F:'EC: ~ I'-:' ~ Cl::l'i ): 1:3t'.,t:F¢ I'dNE:, C:i31'.,IE;"I'i4'.UE:T :r. ON l;:, ~ FIGRFIi"l% RRb: FI',,,'F:I 1Z L,F:IBI.J~: TO :1; I'.,I~;(..II~;:E.'; :i: h,l~.,'i FtLLH I~ ]; CiN. ]. E:b.i:-:.:'l ]JJ'::'~'r' 'I'Hf;It :;t. ]J f:ii"l I:;I:::ti'"i :1; I.. :1~ I::11~'.': t.4 J; 1H THE I_..I_.IL. 2:: J. !-'.t;LLL .ii.N.::, I -ILL. THE .=,'~ .:: I b. fl :[J",l I:i".J:r;:f.~I:;'DFII'.4E:E t.,J~."iH THE' .... "' rV]-W DRILLING, Inc. P,O. Box 44224 * 1310C International Airport Road (907} 274-461] ANCHORAGE, ALASKA 99509 Well Owner_ Location DRILLING LOG : '~ 'J i~.! ''h,i !']~] ~ .Use of Well (address of: Township, Range, Section, if known; or distance main road Size of casing_ Static water level Screen ( Describe screen or perforation Well pumping test at. '-': gallons per (h6fir)' of drawdown from static level. Date of completion_ ::- .Depth of Hole~ }(~ ft. (~b696) Perforated ( i ,,! '/ feet Cased to i, ,! :/ feet (below) land surface. Finish of well (check one) open end .... ; (minute) for. .hours with ~ TM ' ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO TO .TO ; (:' TO. ' ':! TO TO _TO _____TO TO, TO_ TO. __.TO. .TO. .TO .TO 2 -- STATE