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HomeMy WebLinkAboutUS SURVEY 3202 LT 4 T10N R1W SEC 10Onsite File US Survey 3203 Lot 4 #090-022-20 A Municipality of Anchorage f ;;., On=Site Water and Wastewater Section • (907) 343=7904 p8ge 1 of 3 ONi•SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201192 PID Number: 090-022-20 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New [Upgrade Name James Sher ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench A Bed ❑ Mound Site address 351 Auriga Lane *Indian, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-653-7659 (Renter) 4 *3.0 GPD/SF 0.5 Max Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 0.52/0.52 Ft. Subdivision Block Lot US Survey 3202 - 4 Fill added above original grade SEE DWG. Ft. Gravel length 30/31 Ft. Township Range Section N/A Gravel width 5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 300+ Ftz 2 6+ Ft. Well *501+ *50'+ *501+ _25'+ TANK 9 Septic El$,T.E.P.: ElHolding [:]Other Manufacturer Capacity Anchorage Tank 1000 Gal. Surface Water *50'+ *50'+ *50'+ - Material Number of compartments Lot Line 5'+ 10'+ 10'+ - NA HDPE 1 Foundation 10,+ 10'+ 10'+ _ LIFT STATION Manufacturer Capacity Remarks *CAT II AWWTS Anchorage Tank 1000 Gal. Per Contractor, old tank was decommissioned per UPC Alarm location REMOTE MONITORING Electrical installed by Aaf2,,,-J C�r�Fi Installer Tank to PIPE MATERIAL House to tank D3034 F628 drainfield Northern Excavation Draintield D3034 Co/MT D3034 Inspector Garness Engineering Group, Ltd. BENCH MARK' (Assumed elevation) 100.59 ft Inspection 15' 10/5/20 2nd 10/7/20 Location and description 3rd 10/7/20 41h - Top of MH1 (Garage slab = )100.00 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Sta �o600p Conditional Approval: Date O.... ........0 .Je f y A. orn ss: Q Q 9. CE 7913 Septic System Approved Date I' N avzi . � o cCo Note: this approval does not include well permit requirements. #AECc8e444�0OQQoo��o �I\GV VJ/VL/ 10� Sonja Blewett From: Northern Excavation <northernexcavation@gmail.com> Sent: Wednesday, November 10, 2021 12:48 PM To: Sonja Blewett Subject: FW: 351 Auriga lift station electrical install Hey Sonja, here is the letter from the electrician for 351 Auriga. Holler if you need anything else. Q Alyson Williams Northern Excavation and Construction, LLC 15861 S Birchwood Loop Road Chugiak, AK 99567 (907) 694-1373 northernexcavation@ymail.com www.northernexcavationak.com Sent from Mail for Windows From: plc.chambers@gmail.com Sent: Wednesday, November 10, 202112:36 PM To: Jon Semone Subject: 351 Auriga lift station electrical install In reference to the property 351 Auriga The electrical installation is installed in accordance to the last adoption of NEC for the state and municipal requirements. The redundant alarm and wireless call out is located in the lower shop on a separate circuit. Sincerely, Aaron Chambers eade1831 Power Lighting and Control LLC 242-5211 plc.chambers@gmail.con 1 PERMIT NUMBER: OSP201192 , , / / / NEW DRAINFIELDS / / C04 WT4P ` / / \%SMT! INSULATION 4" THICK 4' ON CENTER OR "MOUND" SOIL TO ENSURE 3 FEET OF SOIL COVER QUANICS POD NEW 1000 GALLON GREER TANK USED AS RE -CIRCULATION TANK NEW 1000 GALLON GREER TANK WATERLINE BETWEEN HOME AND ADU WAS LOCATED BY CONTRACTOR PRIOR TO CONSTRUCTION GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING 3701E TiDOR ROAD. SU'IE. 101 • ANCHORAGE, AK 99507' PHOS (_0;) 33.617- EAX (907) 3 5 32.15 PREPARED FOR. PHONE NUMBER: PAGE NUMBER: JAMES SHER 907-653-7659 2 OF 3 LEGAL DESCRIPTION: A B C D FC01 7.4 31.4 - - FCO2 - - 2.0 27.8 MH 1 23.8 31.2 / ' ST1 27.3 28.3 DBL1 28.5 29.9 DBL2 28.4 30.5 ST2 31.9 36.0 MH2 36.1 39.9 VP1 36.6 43.4 MH3 40.8 48.9 VP2 45.0 53.0 FD 74.8 79.5 MT1 75.9 77.2 C01 74.9 76.8 CO2 101.1 107.0 MT2 101.1 107.3 CO3 78.2 74.4 MT3 80.0 75.3 C04 105.3 104.9 MT4 106.4 105A , , / / / NEW DRAINFIELDS / / C04 WT4P ` / / \%SMT! INSULATION 4" THICK 4' ON CENTER OR "MOUND" SOIL TO ENSURE 3 FEET OF SOIL COVER QUANICS POD NEW 1000 GALLON GREER TANK USED AS RE -CIRCULATION TANK NEW 1000 GALLON GREER TANK WATERLINE BETWEEN HOME AND ADU WAS LOCATED BY CONTRACTOR PRIOR TO CONSTRUCTION GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING 3701E TiDOR ROAD. SU'IE. 101 • ANCHORAGE, AK 99507' PHOS (_0;) 33.617- EAX (907) 3 5 32.15 PREPARED FOR. PHONE NUMBER: PAGE NUMBER: JAMES SHER 907-653-7659 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: USS 3202; LOT 4 PNB TYPE OF WORK: DATE: SEPTIC SYSTEM RECORD DRAWING 11/6/20 1 PARCEL ID NUMBER: 090-022-20 a APPROXIMATE LOCATION OF "TOE" OF MOUND - TO BE TOPSOILED AND SEEDED IN SPRING 2021 �NG 1 BEDROOM ADUe a D �1 R�. DRIVEWAY 'T2 + /jFCO EXISTING 3 BEDROOM HOUSE/ 50' LOT5 LOT 11 OF A,Cgs�OpG �. 49 TH s SHANE A. HOLT >°�t LS -6914 u4���°des siona\ \-aoao LOT2 M • • •• 's/�G�EFgM/!Y 0 e • N MHS • MHS t •^a SINGLE FAMILY WATER TANKESM'T BOOK2728 PAGE 504 LOT3 .GRAVEL PPRKINN AREA 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 ( 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. 19,/1-1(11, SURVEY UPDATED NOV. 22 2021 • SEWER SYSTEM PIPE O MANHOLE AS -BUILT SURVEY i" =501 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT4, L/SSURVEY3202 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 22ND DAY OF NOVEA48ER , 2021 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 14565, FB 203-36,219-41 907.223.8615 MUNICIPALITY OF ANCHORAGE Onsite Water R Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:dwww. mu ni.orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP201192 Work Type: Septic Upgrade Tax Code Number: 09002220000 Effective Date: Site Legal Address: US SURVEY 3202 LT 4 T10N R1 W SEC 10 G:4760 Site Mailing Address: 351 AURIGA LN, Indian Owner: SHER JAMES R Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Q Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy Expiration Date Lot Size in Sq Ft: Total Bedrooms: )rpartnna,t 7/31/2020 7131/2021 108900 ❑ 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 Date. s he Date: 113 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201192, Rebecca Carroll, 07/31/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201192, Rebecca Carroll, 07/31/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201192, Rebecca Carroll, 07/31/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201192, Rebecca Carroll, 07/31/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201192, Rebecca Carroll, 07/31/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201192, Rebecca Carroll, 07/31/20 MUNICIPALITY OF ANCHORAGE �Jj , Development Services Department p p � � � Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 090-022-20 Certificate of On -Site Systems Approval Expiration Date: 2 Legal description USS 3202 LOT 4 Site address 351 Auriga Lane Bird Creek Current property owner(s) James Sher X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: Z ZD'Z 3 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 Other COSA ApprovaLiune 2022 Development Services Department 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. 090-022-20 Complete legal description USS 3202; LOT 4 Location (site address) 351 AURIGA LANE *BIRD CREEK, ALASKA Current property owner(s) JAMES SHER (AGENT NUMBER) Day phone 907-250-0333 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: FEil Private Well ❑ Private Well serving 2 dwelling units ❑ 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 FNI Plastic ❑ Concrete ❑ Fiberglass Age 2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: A AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ 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 $ .65 U Waiver Fee $ Date of Payment I IAS (�®as Date of Payment COSA # 05C l 0 %3 Waiver # &gog6 COSA Applleation_June 2022 Legal Description: USS 3202; LOT 4 Parcel ID: 090-022-20 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 10/3/79 Total depth 85 ft Cased to 85 ft )31I Z2 Well production at time of test 8.5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No 'Sanitary seal is functioning correctly 'Coliform bacteria is Negative Wires are properly protected Nitrate 0.394 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 12+ in. Arsenic ug/L AArsenic less than MRL (ND) Date of flow test for COSA 1/12/2023 Collected by GEG Static water level at beginning of test 19.5 ft. Date 1/12/2023 Comments A CLEARER COPY OF THE WELL LOG IS ATTACHED WITH THE COSA Al ALL standpipes present per recor drawing Total measured depth from grade 37537 ft (max) Measured depth to pipe invert from ade Z'" ft (min) ❑ N/A — pressurized field. 0 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 - gallons - date Any rejuvenation treatment (past 12 months) - If yes, enter date - Results Q Pass Fluid depth prior to test DRY in Water added gal New fluid depth *** in Elapsed time *** min Final fluid depth *** in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in IR Comments/Deficiencies: "'PER DISCUSSIONS WITH THE MOA AN ADEQUACY TEST WAS NOT REQUIRED. THE SYSTEM WAS INSTALLED IN 2020 AND HAS BEEN VACANT SINCE JULY OF 2022 (PER AGENT). IN SHORT, THE SYSTEM WAS USED FOR LESS THAN TWO YEARS ALL MTS WERE DRY ON 1/1212023 DURING GEG INSPECTION COSA Checklist June 2022 FAX B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank - /a 0 Required maintenance completed Date of pumping SEE MAINT AGREEMENT =' Age of lift station 2 years U 0 Required maintenance completed, if AWWTS 44 q, Lift station material PLASTIC Comments: NEWER SYSTEM INSTALLED IN 2020 1 Comments: -DATA TAKEN FROM INSPECTION REPORT *`EAST/WEST `7 rG- J D. ABSORPTION FIELD DATA 71 Which system tested (date installed) 2020 Adequacy test date N/A Al ALL standpipes present per recor drawing Total measured depth from grade 37537 ft (max) Measured depth to pipe invert from ade Z'" ft (min) ❑ N/A — pressurized field. 0 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 - gallons - date Any rejuvenation treatment (past 12 months) - If yes, enter date - Results Q Pass Fluid depth prior to test DRY in Water added gal New fluid depth *** in Elapsed time *** min Final fluid depth *** in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in IR Comments/Deficiencies: "'PER DISCUSSIONS WITH THE MOA AN ADEQUACY TEST WAS NOT REQUIRED. THE SYSTEM WAS INSTALLED IN 2020 AND HAS BEEN VACANT SINCE JULY OF 2022 (PER AGENT). IN SHORT, THE SYSTEM WAS USED FOR LESS THAN TWO YEARS ALL MTS WERE DRY ON 1/1212023 DURING GEG INSPECTION COSA Checklist June 2022 FAX E. SEPARATION DISTANCES 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 *50'+ ft E Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Q Yes if No *50'+ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑o Yes if No ft Q 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' ❑ Yes if No *50'+ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS *AWWTS [E Yes if No ft 0 Yes if No ft 0 Yes if No ft R Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No *50'+ ft 0 Yes if No ft If tank or field is under driveway comment below 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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness 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 The reported results describe the condition of the system/s on the date/s of the evaluation. practices. Separation distances were measured to readily identifiable features. Hidden defects or o encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend Qo�� upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate p .•' �% during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing . ' T T/ 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) regardin 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 e ey A. ness, adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEGa C — 3 to perform the evaluation. Reliance upon the information provided in this report by any other person or party ( • ! 2• �� (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.( e coo LICENSE©��Pro-fes-s}a� oma' COSA Checklist June 2022 uAsecaaz I MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ( I +" Day of J A-', Pvizy of 20 7-3 ) by and between COD-/ ?41 t -L.1 PS , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 5e } ; C S trn (r -,e Si c(e i f i^I located at (legal description) 3v2ic,NDiArJ AIC aq.s o 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) CP Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. C P It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). CP Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. CF Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 CP Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. CP Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. CP Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. CP Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. CP Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the constriction, maintenance and repair of the Owner's AWWTS. CP Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The tern of this Agreement shall begin on the date sof approval by the Municipality to operate the installed system; or upoii transfer of title, and shall continue while the AWWTS is operational or until title'is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void.` 6. Jurisdiction: Choice of Law. Anycivil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By:(signature) Date: 01/1 ( /Z,02,3 Co D y P/4 / L L, p$ (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoin 1 strument was acknowledged before me this �%44, day of 202 ,by_ CO0 NO ARY PUBLIC FOR ALASKA AMERICA MAGANA My Commission expires: SKI!, 5 Za Notary Public -4 State of Alaska My Commission Expires Jul 5, 2026 Date: Title: C v ( L— (rev. 05/18/2018) Page 3 of 3 • ��1 ALASQ RETURN TO:" Division of Geological and Geophysfat $s �i(l�Tt + p$g3214g2�-3 Of f NATURAL RF OURCE! 3001 Porcupine Drive (Telephone: 2 a �' jj L i DEPARTMENT OF NATURAL RESOURCE: Anchorage, Alaska 99501 LOC A � � O (313 S WATER ELL R'EC ORD a Drilling Company Name FQ 3Su DRILLING U.S.G.S. Local ilo. Drllllna Permit No. LOCATION OF WELL Please complete either la, ib, or lc. A.D.L. No. la./8/r/0h// MR SAIAVXr/ /T101y lb. FractionTownship / / -/!q�( I Range E Meridian M1 Slie uX11- a1 lc. Distance and Direction from Road IntersectionsN0�/ VV 2 Div. Of Street Address and Area of Well Location '�ehor 7.q3. OWNER OF WELL:aobert, Delak �Address:: f Indian Alaska 99540 Survey 2. WELL LOG Feet Below Surface Material Type Top Bottom 4- WELL DEPTH: (completed) ft. Surface Elevation Date of Completion 5. Cable tool Rotary 11Driven Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: ALv ALV14 Grey Hard 6. USE: ® Domestic Public Supply 13Industry El Irrigation ❑Recharge ❑Commarcial Test Weli Other: ALVM44 Grey Mad EiILL ALVM Dk. Grey Med Gray 7. CASING: [3 Threaded ® Welded 6 In. to _8 5 t. Depth Weight lbs/ft. in, to ft. Depth 8. FINISH OF WELL: Type: Qnen Rnd Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9. STATIC WATER LEVEL: 1 7 ft. Above ® Below land surface Type of Measurement: Well 3o1Lndpr 10. PUMPING LEVEL below land.surface 83__ ft. after _ ]_ hrs. pumping _ 10 g.p.m ft. after hrs. pumping g.p.m 11. WELL HEAD COMPLETION: C]In Approved Pit [:)Pitless Adapter inches above grade 12. GROUTING: Well Grouted: 12Yes C] No Material: ❑ Neat Cement ❑ Other: N8 - ]2•A 13. PUMP: (If available) HP Length of Drop Pipe ft, capacity g.p Type: ❑ Submersible ❑ R.Ip'rocating ❑ Jet ❑ Other: 14. REMARKS: 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: F033 DRILLTNG AA 07SA Registers ed Business Name on r ct License Number Address: �3� angry 9t set aher�g� f Al aAkja 9Q501� _ ^ STATE OF ALASKA 8695 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey O."r, WATER WELL LOG Revised 08/18/2016 Drillinq Started: _/ / Completed: 10 / 3 / 1979 Pump Install: City/Borough Subdivision Block Lot Property Owner Name & Address ROBERT D E LAK Municipality of Anchorage USS 3202 L04 , Well location: Latitude Longitude Meridian S Township 01ON Range 001W Section 10 , SW 1/4 of SW 1/4 of NW 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Drilling method. -air rotary,Fable tooloOther Suggest T.M. Hanna's hydrogeologic classification system* https://my.ngwa.org/NC Product? id=a 185000000BYub3AAD Well use:®Public supply,®Domestic,QReinjection,OHydrofracking I❑ Commercial,DObservation/Monitoring,OTest/Exploratory,[]Cooling, ®Irrigation/Agriculture,D Grounding,[]Recharge/Aquifer Storage, Heating, ®Geothermal Exploration, ©Other Fluids used: . Depth From To Depth of hole: 85 ft Casing stickup: ft Casing type: Casing thickness: inches Casing diameter: inches Casing depth: ft Liner type: Depth: ft Diameter: inches Note: Well intake opening type: Ll Open end, pen hole, E Other Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, Perforated[]Yes i■ No Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packed I❑yes E No Gravel start: ft, Gravel stop: ft Note: Static water (from top of casing): 17 ft on / / Artesian well Pumping level & yield: feet after hours at 10 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?Elyes■- No Water quality parameters tested: Welldriller name: .................................................................................. Company name:.FOSS.DR1L.LIN.G ............................................................. Mailingaddress: .................................................................................... N h 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 Driller's 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://dnr.alaska.gov/welts/ within 30 days of well completion. OR email electronic well logs to City Permit Number: Date of Issue: dnr.water.reportsta'D.alaska.gov Parcel Identification Number: 'Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press WELL OWNER LOCATION ~. ~ S .~ ~Z~/. ~/~ WATER WELL LOG ~ FOSS DRILLING 1336 Ingra Street Anchorage, AXaska 99501 oF WELL SIZE OF CA~ING~DEPTH OF HOLE_~m~T. STATIC WATER LEVEL / 7 , ,PT. YIELD PE~ DP D~A~OWN. REMARKS DATE COMPLETED / ~- ~L~ 9 PUMP TO BE SET AT DEPT. O~ HEALTH & I:NVlRONMENTAL PROT, E, CTION NflV :: 1979 RrC[I¥[~ to F'ERH;( T NO. FiF:"PL I CRNT LOCRT i ON L. EGFtL F_)R JRMES SHER GEN [)EL. I Ni} i FIN FIK LO'T SIZE: FEET t'!):NIi',/i..!bi [;,ISTF!NCE BETI4EEN F:! !4ELL FIND Ri'.,!¥ Eft,i-SITE E;Ei,iFIGE DiSPOSF:tL. SVS'TEH j. Eu;;~ FEET F'OI;~: f:l PRIVRT,E? kiEL.l_; OR iSEi TO ;;:'.E~Ei FEET FF?.EIH R PLIE'IL!C t,.!ELL [;,EPEI'qD)]",!G UPON ]'PIE T'¢F:'E OF F'tJF31..:[C i.,.E:il L.. HELL t_.OLq~.:, Ri:;'.E I',?.EQIJtREi) RH[:, MUST BE RETLIf;'.NEI} TO THE DEI.::'f%;'.-f'I'!ENT HI't'HiN OF THE 1.4EL!. COMPLETIOi",I. O'i'i.IE%?. I'?.Eri;!lJ ): R!~I"tENTS HFt'r' Fh~::'F'L"¢. SPEC ]: FI CFIT ! Oi",!~:E; F'iND CONSTRUCT I Iii",! D ! l:t(.~r~?.l::!b!::~; t:::IRE; F:P/Ff:fMZE:L.i}: TO INSURE F'ROF'ER i NSTRI_LRTION. I E:EF.'T i F'-r' TIJRT fL: I RH FF~H.'_rL. IF!R t,.K!:TPI TF-iE~ REQUIREHENTS FOR ON.-.SITE; SE!.,.IEfRS FIND HELLS F:k:i; 'E;ET F'OF:'f'H B"r' 'T,'-4E I"IlJN!CIPRLZ'T"r' 0t':' FIF,!C. HORfiGE. 2: ! 1.4ZLL INSTR[..L T'HE S'¢STE':H iN RCCO[4:DIqNCE HITH 'FFIE CODES.