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GHD | 14998 West 6th Avenue Suite 800 Golden Colorado USA 80401 | 620518 | 2018.1 | Report No 46| September 5 2018
Well Decommissioning Report Former Chevron-Branded Service Station 94115 11460 Old Seward Highway Anchorage, Alaska ADEC File ID: 2100.26.012 Hazard ID: 24094 Chevron Environmental Management Company
GHD | Well Decommissioning Report | 620518 (46) | Page i
Table of Contents
1. Introduction ................................................................................................................................... 1
2. Site Background ........................................................................................................................... 1 2.1 Site Description .................................................................................................................. 1
2.2 Site Hydrology .................................................................................................................... 2
2.3 Regional and General Site Geology .................................................................................. 2
2.4 Constituents of Potential Concern and Cleanup Levels .................................................... 2
2.5 Conceptual Site Model ....................................................................................................... 2
3. Monitoring Well Decommissioning ............................................................................................... 3
3.1 Well Decommissioning Rationale ...................................................................................... 3
3.2 Pre-Field Coordination and Site Safety ............................................................................. 3
3.3 Monitoring Well Decommissioning ..................................................................................... 3
3.4 Investigation Derived Waste .............................................................................................. 4
4. Conclusion .................................................................................................................................... 4
Figure Index Figure 1 Vicinity Map
Figure 2 Site Plan
Table Index
Table 2.1 Constituents of Potential Concern ..................................................................................... 2
Appendix Index Appendix A Site Photos
Appendix B Site Environmental History
Appendix C CSM Scoping and Graphic Forms
Appendix D QEP Resumes
Appendix E ADNR Well Record of Decommissioning Forms and Original Well Logs
Appendix F GHD Field Notes
GHD | Well Decommissioning Report | 620518 (46) | Page ii
List of Acronyms and Abbreviations AAC Alaska Administrative Code
ADEC Alaska Department of Environmental Conservation
ADNR Alaska Department of Natural Resources
COPCs constituents of potential concern
CSM conceptual site model
DRO diesel range organics
fbg feet below grade
ft btoc feet below top of casing
GRO gasoline range organics
mg/kg milligrams per kilogram
mg/L milligrams per liter
No number
P.G. Professional Geologist
PVC polyvinyl chloride
QEP qualified environmental professional
UST underground storage tank
GHD | Well Decommissioning Report | 620518 (46) | Page 1
1. Introduction
GHD is submitting this Well Decommissioning Report to the Alaska Department of Environmental Conservation (ADEC) on behalf of Chevron Environmental Management Company (Chevron) for former Chevron-branded service station 94115 in Anchorage, Alaska. GHD submitted a Cleanup Complete Request to the ADEC on June 13, 2017. In a September 28, 2017 correspondence, ADEC recommended the site for closure and requested a work plan detailing decommissioning of site wells in order to obtain site closure. On June 6, 2018, ADEC approved GHD’s March 13, 2018 Well Decommissioning Work Plan detailing well decommissioning scope for remaining monitoring wells (MW-1R, MW-4R, MW-11R, MW-15RR, and MW-16 through MW-19). GHD decommissioned all remaining monitoring wells on June 13, 2018.
All field work and reporting were completed in accordance with:
• ADEC’s March 7, 2017 Site Characterization Work Plan and Reporting Guidance for Investigation of Contaminated Sites
• ADEC’s September 2013 Monitoring Well Guidance
• GHD’s March 13, 2018 Well Decommissioning Work Plan approved by ADEC on June 6, 2018
• Field work and reporting were supervised and/or performed by qualified environmental professionals (QEP), in accordance with Title 18 Alaska Administrative Code (AAC) 78 and 18 AAC 75.325 – 75.390
The site background, monitoring well decommissioning, and conclusion are outlined in the following sections.
2. Site Background
2.1 Site Description
Former Chevron-branded service station 94115 is located at 11460 Old Seward Highway in a mixed commercial and residential area of Anchorage, Alaska (Figure 1). The property’s legal description is T12N, R3W, Section 19, and Parcel 7. The latitude and longitude are 61.116969° north and 149.864540° west. The site is a former Chevron-branded service station which operated from 1963 to 2008. Station facilities included three gasoline underground storage tanks (USTs), product lines and dispensers, station building including three service bays, used oil aboveground storage tank, propane tank, office, storage shed and two storage trailers. All station facilities were removed and the service station demolished in January 2008.
Land use surrounding the site is primarily commercial and residential. Businesses are located north, south, and east; residences border the site on the west. The property is currently owned by Hatch Ventures, LLC and is currently occupied by BB’s Coffee Shop in the center of the site and a semi-permanent food truck on the southeast corner of the site. Chevron is the responsible party for the active environmental case.
GHD | Well Decommissioning Report | 620518 (46) | Page 2
The groundwater monitoring well network at the site included five onsite and three offsite wells (Figure 2). Site photographs are presented in Appendix A. Site environmental history is presented in Appendix B.
2.2 Site Hydrology
The site is located in south central Alaska, southeast of the northern Knik Arm of Cook Inlet. Historical static groundwater depths ranged between 31.40 and 45.48 feet below top of casing (ft btoc) from 1995 to present. Groundwater dominantly flowed northwest.
2.3 Regional and General Site Geology
Anchorage area bedrock consists of Mesozoic metamorphic and igneous rocks overlain by densely consolidated sediments of the Kenai group. A series of marine transgressive sequences combined with glaciofluvial sediments are overlain by the most recent glacial sediments.
Site subsurface sediments consist primarily of well graded sand with gravel to approximately 10 feet below grade (fbg), underlain by poorly graded sand to approximately 40 fbg, underlain by silt to the total explored depth of 57 fbg.
2.4 Constituents of Potential Concern and Cleanup Levels
Historical site constituents of potential concern (COPCs) have been those listed below; however, site soil and groundwater concentrations are below cleanup levels and no longer present a health risk.
Table 2.1 Constituents of Potential Concern
COPCs ADEC Cleanup Levels
Groundwater (mg/L) Soil (mg/kg) diesel range organics (DRO) 1.5 250
gasoline range organics (GRO) 2.2 300 benzene 0.0046 0.022
mg/L milligrams per liter mg/kg milligrams per kilogram
ADEC Table C Groundwater Cleanup Levels (Title 18 AAC 75.345) and ADEC Method Two Soil Cleanup Levels, Tables B1 and B2, under 40 inch zone, migration to groundwater (Title 18 AAC 75.341) are the default site cleanup levels for groundwater and soil.
2.5 Conceptual Site Model
GHD maintains a conceptual site model (CSM) for the site. Based on the current site data, all exposure pathways are closed and there are no human receptors (Appendix C).
GHD | Well Decommissioning Report | 620518 (46) | Page 3
3. Monitoring Well Decommissioning
3.1 Well Decommissioning Rationale
Monitoring wells MW-1R, MW-4R, MW-11R, MW-15RR, and MW-16 through MW-19 were approved for well decommissioning by ADEC on June 6, 2018 as the site was granted closure. Decommissioning the wells eliminates the potential for vertical migration of surface contaminants related to current and future site activities.
3.2 Pre-Field Coordination and Site Safety
GHD obtained necessary permits and coordinated site activities with all associated subcontractors, property owners, ADEC, and Chevron. GHD prepared a site-specific health and safety plan to inform all site workers of known hazards and provide health and safety guidance. GHD conducted a pre-field safety meeting with Chevron and all appropriate parties on March 16 and May 30, 2018 and reviewed Chevron and GHD safety protocols with subcontractors at daily tailgate meetings. A journey management plan was prepared to address safety concerns associated with traffic routes and onsite parking. In addition, GHD notified the Alaska Digline on April 25 and May 29, 2018 and observed a third party utility locate and geophysical survey on April 30 and 31, 2018 to clear boring locations of safety hazards. MW-15RR had a natural gas line within three feet and MW-16 had an overhead electric line within 10 feet.
3.3 Monitoring Well Decommissioning
Monitoring wells MW-1R, MW-4R, MW-11R, MW-15RR, and MW-16 through MW-19 were decommissioned on June 13, 2018. Oliver Yan and Travis Weaver, both QEPs, oversaw decommissioning activities. Fieldwork and reporting were supervised by QEP, Derek Wilken. QEP resumes are included in Appendix D.
None of the well casings were completely removed during decommissioning because the well casing broke at ground surface or part way down. After the first casing broke, work was stopped and Robert Weimer with the ADEC was contacted by phone. The ADEC approved an alternate method to prevent the borehole from collapsing prior to bentonite being added. The well vault and concrete pad were removed using a Geoprobe drill rig. The bottom of the well casing was knocked out using the direct push drilling rods. The polyvinyl chloride (PVC) casing was used as a tremie pipe to fill the screened interval with sand and the blank casing with bentonite chips hydrated at five foot intervals. The Geoprobe was used to remove as much of the casing as possible. Most casings broke at the threaded seam at 7 to 10 fbg. MW-1R, MW-4R and MW-16 broke near the surface so a pipe splitter was driven to a depth of 5 fbg to destroy the casing. The top foot was filled with gravel to match grade. Bridging occurred while backfilling so there is a potential for up to a 10 foot void in the seal of MW-4R and MW-16. Robert Weimer was notified by phone.
MW-15RR was decommissioned in place because of the safety risk presented by the natural gas line within three feet of the well. This was approved on a phone call with Robert Weimer. The screened interval was filled with sand and the remainder of the casing filled with bentonite chips and hydrated at five foot intervals. The well lid was removed and the vault was filled with concrete.
GHD | Well Decommissioning Report | 620518 (46) | Page 4
The Alaska Department of Natural Resources (ADNR) Well Record of Decommissioning forms and original well logs are presented in Appendix E. GHD field notes are presented in Appendix F.
3.4 Investigation Derived Waste
All investigation-derived waste, including all PVC casing and concrete debris were transported by the subcontractor to an Alaska-approved waste landfill.
4. Conclusion
Groundwater monitoring wells MW-1R, MW-4R, MW-11R, MW-15RR, and MW-16 through MW-19 were properly decommissioned in accordance with GHD’s March 13, 2018 Well Decommissioning Work Plan and discussions with Robert Weimer of ADEC to address site conditions.
GHD was pleased to work with the ADEC on this project. Please contact GHD project manager, Siobhan Pritchard, at 970-222-3220 or via email at [email protected] with any questions regarding the work outlined above.
All of Which is Respectfully Submitted,
GHD
Derek Wilken
Oliver Yan
Travis Weaver
GHD | Well Decommissioning Report | 620518 (46)
Figures
SOURCE: USGS QUAD MAPS; ANCHORAGE A-8 NW AND SW, AK, 2016.
ALASKA
0 1000 2000ft 2000.000020 0
CAD File: P:\drawings\620000s\620518\620518-REPORT\620518-2018.1(046)\620518-2018.1(046)GN\620518-2018.1(046)GN-WA001.DWG
Jul 11, 2018
620518-2018.1
FIGURE 1
FORMER CHEVRON-BRANDED SERVICE STATION 9411511460 OLD SEWARD HIGHWAYANCHORAGE, ALASKA
VICINITY MAP
SITE
PROPANE TANK
SEPTIC TANK
FORM
ER
USTs
DISPENSER ISLANDS
CENTER STREET
VACANTLOT
TRAI
LER
TRAI
LER
BARBERSHOP
MW-9
MW-14
MW-5
MW-6
MW-4 MW-3
MW-8
MW-1 MW-2
TP-1 (SVE/AS)
MW-7
SVE/AS-3
TP-3 (SVE/AS)
SVE/AS-4TP-4 (SVE/AS)
MW-11TP-2 (SVE/AS)
MW-12
MW-15
MW-13
MW-12
MW-15R
Wilson-1
FORMERSHEDS
FORMER 1,000 GAL.USED OIL TANK
FORMERSVE SYSTEMPIPING
DUAL LIFTHYDRAULIC HOIST
FORMERREMEDIATION
SYSTEMCOMPOUND
FORMERSTATIONBUILDING
BB'SCOFFEE
SHACK
FORMER SVESYSTEM PIPING
SVE/AS-1
FORMERUST
MW-10
MW-10(R)
SITEPROPERTY
OVERHEADLINES
VACANTLOT
WENDY'SRESTAURANT
OLD
S
EW
AR
D H
IG
HW
AY
MW-16 MW-4R
MW-17
MW-19
MW-15RR
MW-18
PSW29-1
MW-11R
MW-1R
SEMI-PERMANENTFOOD TRUCK
OVERHEADLINES
0 20 40ft 40.000000
0.025
CAD File: P:\drawings\620000s\620518\620518-REPORT\620518-2018.1(046)\620518-2018.1(046)GN\620518-2018.1(046)GN-WA002.DWG
Aug 15, 2018
620518-2018.1
FIGURE 2
FORMER CHEVRON-BRANDED SERVICE STATION 9411511460 OLD SEWARD HIGHWAYANCHORAGE, ALASKA
SITE PLAN
LEGEND
DOMESTIC WELL LOCATION
DECOMMISSIONED MONITORING WELL LOCATION
UTILITY POLE
GHD | Well Decommissioning Report | 620518 (46)
Appendices
GHD | Well Decommissioning Report | 620518 (46)
Appendix A Site Photos
CAD File: P:\drawings\620000s\620518\620518-REPORT\620518-2018.1(046)\620518-2018.1(046)GN\620518-2018.1(046)GN-WA003.DWG
Jul 11, 2018
620518-2018.1FORMER CHEVRON-BRANDED SERVICE STATION 9411511460 OLD SEWARD HIGHWAYANCHORAGE, ALASKA
SITE PHOTOGRAPHS
Photo 1 - MW-1R facing south. Photo 2 - MW-4R facing east.
Photo 3 - MW-11R facing north. Photo 4 - MW-15RR facing south.
Photo 5 - MW-16 facing northeast.
CAD File: P:\drawings\620000s\620518\620518-REPORT\620518-2018.1(046)\620518-2018.1(046)GN\620518-2018.1(046)GN-WA003.DWG
Jul 11, 2018
620518-2018.1FORMER CHEVRON-BRANDED SERVICE STATION 9411511460 OLD SEWARD HIGHWAYANCHORAGE, ALASKA
SITE PHOTOGRAPHS
Photo 6 - MW-17 facing west. Photo 7 - MW-18 facing west.
Photo 8 - MW-19 facing east. Photo 9 - Geoprobe.
GHD | Well Decommissioning Report | 620518 (46)
Appendix B Site Environmental History
GHD | Well Decommissioning Report | Appendix B | 620518 (46) | Page 1
Appendix B Environmental Site History Chevron 94115
1991 Monitoring Well Installations Petroleum-impacted soil was observed during excavation and repair of a leach field drain line. Eight groundwater monitoring wells (MW-1 through MW-8) were installed. Details are presented in America North/EMCON, Inc.’s December 20, 1991 Environmental Assessment Report. 1992 Monitoring Well Installations Six monitoring wells (MW-9 through MW-14) were installed. Light non-aqueous phase liquid was observed in MW-1. No petroleum hydrocarbons were detected above cleanup levels in samples collected from nearby drinking water wells. Details are presented in America North/EMCON, Inc.’s September 9, 1992 Dissolved Petroleum Hydrocarbon Plume Delineation report. 1992 Dry Well Removal and Excavation Petroleum-impacted soil was identified during the removal of a dry well south of the station building. Approximately 500 cubic yards of soil were transported to Alaska Soil Recycling for thermal treatment. Details are presented in America North/EMCON, Inc.’s October 13, 1992 Dry Well Excavation and Closure report. 1995 Monitoring Well Installation Groundwater monitoring well MW-15 was installed downgradient (north) of the site property. Details are presented in Groundwater Technology’s August 31, 1995 Monitoring Well Installation Report. 1998 UST Removal SECOR International, Inc. of Sacramento, California (SECOR) coordinated the removal and assessment of five underground storage tank (UST) systems at the site. Three gasoline USTs, one heating oil UST and one used oil UST were removed. Details are presented in the August 7, 1998 SECOR Underground Storage Tank Removal and Site Assessment Report. 1999 Dry Well Removal and Excavation A dry well near the northern property line was removed and over-excavated on June 7, 1999. Approximately 120 cubic yards of soil was excavated from the location and transported to Alaska Soil Recycling for thermal treatment. Details are presented in SECOR’s December 29, 1999 Dry Well Removal Report. 1999 SVE Installation SECOR installed four dual completion soil vapor extraction and air sparge wells SVE/AS-1 through SVE/AS-4. Details are presented in SECOR’s November 11, 1999 Dual Completion SVE/AS Well Installation and Slug Test Report. 2003 Site Assessment SECOR installed groundwater monitoring wells MW-10R and MW-15R and abandoned seven monitoring wells (MW-2, MW-3, MW-4, MW-5, MW-8, MW-13 and MW-14). Details are presented in SECOR’s July 30, 2003 Well Installation and Destruction Report.
GHD | Well Decommissioning Report | Appendix B | 620518 (46) | Page 2
2008 UST Removal and Well Decommissioning GHD (formerly CRA) coordinated the excavation of five USTs and a wooden box crib and collected soil assessment floor samples from each excavation. Twelve groundwater monitoring wells (MW-1, MW-6 MW-7, MW-9, MW-10R, MW-11, SVE/AS-1, SVE/AS-2, SVE/AS-4, TP-1, TP-2, and TP-4) were decommissioned. Details are presented in the March 27, 2008 GHD UST Compliance Sampling and Well Decommissioning Report. 2008 Site Assessment GHD advanced nine soil borings (SB-1 to SB-5, MW-1R, MW-4R, MW-11R and MW-16) and installed four monitoring wells. Details are presented in the October 16, 2008 Subsurface Investigation and Well Installation Report. 2009 Site Assessment GHD advanced four soil borings (SB09-01, SB09-02, SB09-03 and SB09-04) and coordinated a shallow excavation of visibly impacted surface soil at the site. Details are presented in the GHD Subsurface Investigation Report dated April 6, 2010. 2010 Site Assessment GHD advanced three soil borings (SB-10, MW-15RR and MW-17) and installed two monitoring wells at the site. Details are presented in the GHD Subsurface Investigation Report dated January 24, 2011. 2015 Monitoring Well Installation GHD installed two groundwater monitoring wells (MW-18 and MW-19) downgradient of the site. No COPCs were detected above ADEC cleanup levels in groundwater or soil samples. Details are presented in the GHD 2015 Groundwater Monitoring Well Installation Report dated March 8, 2016. 2018 Monitoring Well Decommissioning GHD decommissioned the eight remaining groundwater monitoring wells (MW-1R, MW-4R, MW-11R, MW-15RR, and MW-16 through MW-19).
GHD | Well Decommissioning Report | 620518 (46)
Appendix C CSM Scoping and Graphic Forms
Appendix A - Human Health Conceptual Site Model Scoping Form and Standardized Graphic
Site Name:
File Number:
Completed by:
Introduction The form should be used to reach agreement with the Alaska Department of Environmental Conservation (DEC) about which exposure pathways should be further investigated during site characterization. From this information, summary text about the CSM and a graphic depicting exposure pathways should be submitted with the site characterization work plan and updated as needed in later reports.
General Instructions: Follow the italicized instructions in each section below.
* bgs - below ground surface
1. General Information:Sources (check potential sources at the site)
USTsASTsDispensers/fuel loading racks Drums
VehiclesLandfillsTransformers
Release Mechanisms (check potential release mechanisms at the site)SpillsLeaks
Direct dischargeBurning
Impacted Media (check potentially-impacted media at the site)
Other:
Residents (adult or child)Commercial or industrial workerConstruction workerSubsistence harvester (i.e. gathers wild foods)Subsistence consumer (i.e. eats wild foods)
Site visitorTrespasserRecreational userFarmer
Surface soil (0-2 feet bgs*)Subsurface soil (>2 feet bgs)
GroundwaterSurface water
Other:
Air BiotaSediment
Receptors (check receptors that could be affected by contamination at the site)
Other:
Other:
1 revised January 2017
2. Exposure Pathways: (The answers to the following questions will identify completeexposure pathways at the site. Check each box where the answer to the question is "yes".)
a) Direct Contact -1. Incidental Soil Ingestion
Are contaminants present or potentially present in surface soil between 0 and 15 feet below the ground surface? (Contamination at deeper depths may require evaluation on a site-specific basis.)
If the box is checked, label this pathway complete:
Comments:
2. Dermal Absorption of Contaminants from SoilAre contaminants present or potentially present in surface soil between 0 and 15 feet below the ground surface? (Contamination at deeper depths may require evaluation on a site specific basis.)
If both boxes are checked, label this pathway complete:
Comments:
Can the soil contaminants permeate the skin (see Appendix B in the guidance document)?
b) Ingestion -1. Ingestion of Groundwater
Have contaminants been detected or are they expected to be detected in the groundwater, or are contaminants expected to migrate to groundwater in the future?
If both boxes are checked, label this pathway complete:
Comments:
Could the potentially affected groundwater be used as a current or future drinking water source? Please note, only leave the box unchecked if DEC has determined the ground- water is not a currently or reasonably expected future source of drinking water according to 18 AAC 75.350.
revised January 2017 2
2. Ingestion of Surface Water
Have contaminants been detected or are they expected to be detected in surface water, or are contaminants expected to migrate to surface water in the future?
If both boxes are checked, label this pathway complete:
Could potentially affected surface water bodies be used, currently or in the future, as a drinking water source? Consider both public water systems and private use (i.e., during residential, recreational or subsistence activities).
Comments:
3. Ingestion of Wild and Farmed Foods
Is the site in an area that is used or reasonably could be used for hunting, fishing, or harvesting of wild or farmed foods?
If all of the boxes are checked, label this pathway complete:
Comments:
Do the site contaminants have the potential to bioaccumulate (see Appendix C in the guidance document)?
Are site contaminants located where they would have the potential to be taken up into biota? (i.e. soil within the root zone for plants or burrowing depth for animals, in groundwater that could be connected to surface water, etc.)
c) Inhalation-1. Inhalation of Outdoor Air
Are contaminants present or potentially present in surface soil between 0 and 15 feet below the ground surface? (Contamination at deeper depths may require evaluation on a site specific basis.)
If both boxes are checked, label this pathway complete:
Are the contaminants in soil volatile (see Appendix D in the guidance document)?
Comments:
3 revised January 2017
2. Inhalation of Indoor AirAre occupied buildings on the site or reasonably expected to be occupied or placed on the site in an area that could be affected by contaminant vapors? (within 30 horizontal or vertical feet of petroleum contaminated soil or groundwater; within 100 feet of non-petroleum contaminted soil or groundwater; or subject to "preferential pathways," which promote easy airflow like utility conduits or rock fractures)
If both boxes are checked, label this pathway complete:
Comments:
Are volatile compounds present in soil or groundwater (see Appendix D in the guidance document)?
4 revised January 2017
3. Additional Exposure Pathways: (Although there are no definitive questions provided in this section,these exposure pathways should also be considered at each site. Use the guidelines provided below todetermine if further evaluation of each pathway is warranted.)
Dermal Exposure to Contaminants in Groundwater and Surface Water
Dermal exposure to contaminants in groundwater and surface water may be a complete pathway if: o Climate permits recreational use of waters for swimming.o Climate permits exposure to groundwater during activities, such as construction.o Groundwater or surface water is used for household purposes, such as bathing or cleaning.
Generally, DEC groundwater cleanup levels in 18 AAC 75, Table C, are deemed protective of this pathway because dermal absorption is incorporated into the groundwater exposure equation for residential uses.
Check the box if further evaluation of this pathway is needed:
Comments:
Inhalation of Volatile Compounds in Tap Water
Inhalation of volatile compounds in tap water may be a complete pathway if: o The contaminated water is used for indoor household purposes such as showering, laundering, and dish
washing.o The contaminants of concern are volatile (common volatile contaminants are listed in Appendix D in the
guidance document.)
DEC groundwater cleanup levels in 18 AAC 75, Table C are protective of this pathway because the inhalation of vapors during normal household activities is incorporated into the groundwater exposure equation.
Check the box if further evaluation of this pathway is needed:
Comments:
5 revised January 2017
Inhalation of Fugitive Dust
Inhalation of fugitive dust may be a complete pathway if: o Nonvolatile compounds are found in the top 2 centimeters of soil. The top 2 centimeters of soil are
likely to be dispersed in the wind as dust particles.o Dust particles are less than 10 micrometers (Particulate Matter - PM10). Particles of this size are called respirable particles and can reach the pulmonary parts of the lungs when inhaled.
DEC human health soil cleanup levels in Table B1 of 18 AAC 75 are protective of this pathway because the inhalation of particulates is incorporated into the soil exposure equation.
Check the box if further evaluation of this pathway is needed:
Comments:
Check the box if further evaluation of this pathway is needed:
Comments:
Direct Contact with Sediment
This pathway involves people's hands being exposed to sediment, such as during some recreational, subsistence, or industrial activity. People then incidentally ingest sediment from normal hand-to-mouth activities. In addition, dermal absorption of contaminants may be of concern if the the contaminants are able to permeate the skin (see Appendix B in the guidance document). This type of exposure should be investigated if: o Climate permits recreational activities around sediment.o The community has identified subsistence or recreational activities that would result in exposure to the
sediment, such as clam digging.
Generally, DEC direct contact soil cleanup levels in 18 AAC 75, Table B1, are assumed to be protective of direct contact with sediment.
6 revised January 2017
4. Other Comments (Provide other comments as necessary to support the information provided in thisform.)
7 revised January 2017
GHD | Well Decommissioning Report | 620518 (46)
Appendix D QEP Resumes
Siobhan Pritchard
1
Oil and Gas – Remediation and Environmental Risk Evaluation Senior Project Manager Mid Way | Baker Hughes | Casper, Wyoming | 2015 - ongoing Siobhan provides senior oversight for field work and project establishment for a Baker Hughes storage facility formerly an asphalt manufacturer facility. She has provided oversight for site investigations to determine the most effective remediation strategy for property divestment. Senior Project Manager Various Projects | Chevron Environmental Management Company | Alaska | 2011 - ongoing Siobhan is responsible for senior management of the Chevron EMC Alaska portfolio including multiple retail remediation sites. Siobhan negotiates remediation strategies based on client interest and state regulations and requirements. Sites are currently at various stages of remediation. Several sites are located in remote areas necessitating additional logistical challenges. Siobhan routinely evaluates and presents remedial alternatives to remediation system teams that satisfy both client expectations and regulatory requirements. Technical Reviewer Various Projects | Various Clients | Alaska, Colorado, New Mexico, Utah, Wyoming | Ongoing Siobhan is the senior reviewer for assessment and remediation reports in several states for legacy pipeline releases, natural gas well sites, production facilities, storage facilities, retail stations, and bulk fuel terminals.
Remediation Activities Senior Project Manager Various Projects | Chevron EMC | Anchorage, Alaska | 2011 - ongoing Siobhan manages several active remediation sites that utilize technology such as air sparge/soil vapor extraction, passive groundwater collection, and in-situ bioremediation. Siobhan has worked closely with
engineers, clients and regulators to develop active remediation strategies that satisfy regulatory requirements as well as cost efficient strategies. She has recently become involved in identifying sustainable remediation strategies, including active remediation, waste disposal and sampling methods. Field Geologist Various Remediation Projects | Various Clients | Colorado and Alaska | 2007 - 2012 Siobhan was responsible for field oversight and knowledge of soil sampling procedures and techniques; groundwater sampling procedures and techniques; subsurface and hydrogeological investigations. Siobhan conducted routine inspections of nitrogen, ozone and oxygen injection remediation systems.
Oil and Gas Upstream/Pipeline Facilities – Site Assessments Project Manager Due Diligence Investigations | Various Clients | Colorado, Wyoming, Utah | 2011 - 2015 Siobhan was the Project Manager for multiple sites as part of due diligence evaluations and liability divestments. Responsible for financial management, site documentation, file review, stakeholder engagement, field activities, site assessments, risk evaluation, and reporting for sites. Project Manager Stormwater Permitting | Various Clients | Colorado | 2010 - 2012 Siobhan was the Project Manager for multiple sites requiring Stormwater Management Plans as well as updating permits and conducting training for compliance with new regulations. Responsible for financial management, site documentation, file review, stakeholder engagement, field activities, site assessments, risk evaluation, and reporting for sites.
Qualified: MA (Structural Geology), 2006, BS, Geology, 2000 Connected: Registered Professional Geologist: Wyoming, Member, Geological Society of America, Member, Colorado Groundwater Association, Member Professional Summary: Siobhan is an effective and articulate communicator who quickly gains the trust and confidence of clients, stakeholders, on-site staff, senior management, and key decision makers. In her 11 years of experience, Siobhan continues to identify opportunities for improvement, make recommendations, and helps implement innovative processes to meet an ever-changing regulatory environments and client's needs.
Siobhan Pritchard
2
Safety Officer Office Safety Officer Various Clients | Denver, Colorado | 2007 - 2012 Siobhan was responsible for preparing health and safety plans, journey management plans, and job safety analyses. Other duties included running office safety meetings, pre field health and safety meetings, and tailgate safety meetings. She provided quality control oversight during groundwater and soil sampling events. She also provided oversight during hot work/high hazard activities.
Geologist and Hydrogeologist Field Geologist Site Assessments | Chevron EMC, Delta Western | Alaska | 2007 - 2012 Siobhan was responsible for coordination and preparation, development, and submittal of proposals to complete site assessment activities within the Alaska Contaminated Sites Program. Siobhan was responsible for the scheduling, planning, field work activities, and reporting of assigned sites. Field Geologist Phase I Environmental Site Assessments | Various Clients | Colorado and Alaska | 2008 - 2012 Siobhan was responsible for Phase I Environmental Site Assessments in Colorado and Alaska in accordance with ASTM Standards. Field Hydrogeologist Dutch Harbor | Delta Western | Alaska | 2011 Siobhan was responsible for oversight for subsurface investigations related to a legacy pipeline release which led to agency closure. Field Geologist Various Remediation Projects | Various Clients | Colorado and Alaska | 2007 - 2012 Siobhan was responsible for field oversight and knowledge of soil sampling procedures and techniques; groundwater sampling procedures and techniques; subsurface and hydrogeological investigations. Siobhan conducted routine inspections of nitrogen, ozone and oxygen injection remediation systems.
Other Geologic Research Field Geologist Various Projects | Colorado, New Mexico, Washington, Ireland, Costa Rica, Argentina, Chile | 1997 - 2000 • Analyzed and mapped shatter cones from the Santa
Fe impact structure.
• Experience with shatter cone petrography to identify impact glass and microscopic shock structures, such as planar deformation features.
• Analyzed Andean Cordilleran and Precordilleran, Costa Rican, Southeastern United States, Wisconsin, and Rocky Mountain geology through mapping formation contacts, fault movement and orientation, rock analysis, grain analysis, and aerial photography analysis.
• Analyzed various lava flows from Volcan Arenal using rock and grain analysis and geochemistry analysis.
• Experience analyzing cores and with log interpretation.
• Conducted 2D and 3D seismic mapping for several large potential oil fields.
• Conducted ground penetrating radar surveys. • Conducted species diversity research in western
Ireland. • Research assistant on a NASA Space Grant studying
near shore shoaling waves and depth to sea floor. • Experience with Fortran 90, Matlab, Unix, Microsoft
Office, Adobe Photoshop and Illustrator, Autocad, and 3D Quickmove.
Other related areas of interest Recognized (Certifications/Trainings) • Loss Preventions Systems
• Federal Regulatory Commission Training
• Alaska Qualified Person • OSHA 40-hour HAZWOPER, 2007 • OSHA 8-hour HAZWOPER refresher,
2008-present Published Refereed Papers • "Shatter Cone Occurrences Indicate a Possible
Impact Structure near Santa Fe, New Mexico, GSA Abstracts with Programs" Vol. 38 n. 7 pp. 298.(with Fackelman, S.P., McElvain, T.H., Morrow, J.R., Koeberl, C., 2006)
• "Shatter cone and microscopic shock alteration for a post Paleoproterozoic terrestrial impact structure near Santa Fe, New Mexico, USA", Earth and Planetary Science Letters v. 207 pp. 209 299.(with • Fackelman, S.P., Morrow, J.R., Koeberl, C., McElvain, T.H., 2008)
Siobhan Pritchard
3
Papers Presented and Published in Conference Proceedings • "Shatter Cone Exposures Indicate a New Bolide
Impact Structure Near Santa Fe, New Mexico", Lunar and Planetary Science Conference XXXVIII.2007
Presentations • Colorado Oil and Gas Association "Environmental
Remediation" luncheon presentation
Work history 2007 – present GHD (formerly Conestoga-Rovers &
Associates), Golden, CO
Travis Weaver Environmental Engineer
Page 1
Qualified: B.Sc., Environmental Engineering and minor in Sustainable and Renewable Energy Systems, University of Wisconsin – Platteville (2015) Connected: Member of Alaska Association of Environmental Professionals (AAEP) 2018 and Alaska Water Well Association (AWWA) 2018 Professional Summary: Travis possesses excellent teamwork and communication skills as demonstrated in his ability to work cross functionally with a respectful demeanor. His strong work ethic and attention to safety ensure high quality work completed the safe way the first time. He has professional experience with: environmental remediation, environmental compliance and auditing, project and contractor supervision, reclamation monitoring on mine sites, and surveying.
Oil and Gas Site Assessments Project Coordinator/Staff Engineer Various Projects | Chevron Environmental Management Company | Alaska | 2017 - ongoing Travis provides field data collection at many active sites through methods such as groundwater, vapor, and soil sampling. This also includes the installation of groundwater monitoring wells, vapor probes, and soil borings. He works with regulators, site owners, subcontractors, clients, and senior management to ensure the best outcome. He analyzes the data and prepares reports including site investigation summary, site closure, and work plans.
Oil and Gas Remediation Project coordinator/Staff Engineer Various Projects | Chevron Environmental Management Company | Alaska | 2017 - ongoing Travis is in charge of daily operation and maintenance, optimization, sampling, and troubleshooting of the air sparge/soil vapor extraction remediation system in Anchorage. This entails HASP and Operation Manual revision, safety inspections, audit preparation, and report generation. He has also conducted in-situ bioremediation. Field Equipment and Fleet Manager GHD | Alaska Office | 2018 - ongoing Travis manages fleet vehicles and field equipment for the GHD Anchorage office. Tasks include, but are not limited to: coordination of fleet maintenance, obtaining field equipment/sampling supplies, and managing all equipment certifications.
Environmental Engineering Environmental Staff Engineer Hormel Foods Corporation | Austin, MN | 2016 - 2017 Travis participated in both regional and corporate environmental program implementation. The environmental programs included: spill prevention,
wastewater, storm water, air, hazardous waste, universal waste, and special pollutants. In the regional role Travis oversaw the implementation of environmental programs at several manufacturing plants. This included: develop and conduct site specific environmental training and SOPs, organize and manage environmental records, implement environmental and sustainability improvement projects, release reporting and documentation, implement asbestos O&M plans, and wastewater sampling and analysis. In the corporate role Travis helped create environmental management system (EMS) guidance and conduct internal audits. Some of these activities included: preparing environmental permits and assessment, drafting EMS guidance based on new regulations, full facility audits, industry partnerships with non-governmental organizations and government agencies to improve water quality and reduce flooding, corporate responsibility reporting and water risk analysis, and participate in the corporate sustainability committee. These efforts helped the company strive to maintain full environmental compliance while minimizing operational costs. Associate Maintenance Engineer Hormel Foods Corporation | Austin, MN 2015 - 2016 Travis managed the performance and maintenance of the manufacturing equipment in a department which produced over a million dollars of product annually. This was accomplished through the supervision of ten mechanical and electrical craftsmen along with the outside contractors, vendors, and technical experts. Some of the tasks included: conduct safety assessments and training, develop maintenance schedules, order parts, track productivity, and troubleshoot broken equipment. Travis was able to build teamwork across shifts and functional groups, reduce equipment downtime and eliminate product loss. This made the department run more efficiently and increase profits by cutting costs.
Travis Weaver
Page 2
Environmental Quality Intern BHP Billiton | Farmington, NM | 2014 Travis helped implement and monitor reclamation activities at a coal mine. As part of this he: conducted erosion and vegetation surveys, sampled soil, surface water, and groundwater, and inspected culverts and storm water ponds. ArcGIS was used to analyze the data and create maps and tables which were used in a report on the effectiveness of the reclamation.
Other related areas of interest Recognized (Certifications/Trainings) • Alaska Qualified Environmental Professional • OSHA 40-Hour Hazardous Waste Operation and
Emergency Response (HAZWOPER) Certified • CPR, AED, and Standard First Aid Certified
• Project Management
• Root Cause Analysis
• DHS chemical-terrorism vulnerability information
Work history 2017 - present GHD Services, Inc. Anchorage, AK
2015 - 2017 Hormel Foods Corporation, Austin, MN
2014 BHP Billiton (Intern), Farmington, NM
2013 - 2014 Research Assistant, Platteville, WI
2013 City of Winona (Intern), Winona, MN
Derek Wilken Project Manager/PG
Page 1
Project Manager Sitka Former Bulk Terminal | Confidential Client | Sitka, AK Planning and coordination of remedial excavation and onsite treatment at remote former bulk terminal. Project efforts include: • Coordination and negotiations with stakeholders,
including regulatory agencies, local government agencies, local tribal council, and local residents.
• Site assessment activities to define scope of excavation and minimize scope of work creep.
• Evaluation and coordination of onsite soil treatment to eliminate logistical complications and hazards with off-island soil transport.
• Coordination with archaeologist for cataloging potential finds of historic and cultural significance.
Project Manager / Project Geologist Ammonia and Fuel Pipeline Releases | Confidential Client | Various Locations in Nebraska Planning and coordination of environmental investigation activities related to gasoline service station releases. Project efforts include: • Management of numerous ammonia and fuel pipeline
release environmental cases in portfolio. • Coordination with regulatory agencies, local
government agencies, and adjacent property owners. • Supervision of assessment activities including: soil
and groundwater borings, groundwater and surface water monitoring, and monitoring well installations.
• Health and safety oversight.
• Operation of remediation systems and reporting.
• Geologic interpretation of soil data. • Preparation of closure documents and coordination
with regulatory agencies.
• Supervision of monitoring well destructions.
Project Manager / Project Geologist Lease Site Environmental Risk Management Program | Confidential Client | Omaha, NE Planning and coordination of environmental investigation activities to identify potential environmental risks associated with leased property for a Fortune 500 company. Project efforts included: • Review of real estate files to identify potential
environmental risks. • Supervision of soil and groundwater investigations at
several properties. - Iron and scrap metal yard in OK. - Agricultural coops in various cities in NE and TX. - Fertilizer distribution centers in various cities in
NE. - Fuel distribution facilities in various cities in IL,
AR, and TX. Project Manager Product Pipeline Release Assessment | Confidential Client | Gardena, CA Planning and coordination of assessment activities related to a product pipeline release. Project efforts included: • Coordination and negotiations with stakeholders,
including regulatory agencies, local government agencies, and adjacent businesses.
• Assessment using cone penetrometer testing (CPT) equipped with ultra-violet optical screening tool (UVOST) to identify the presence and extent of non-aqueous phase liquids (NAPL).
• Interpretation of investigation data and planning for future scopes of work.
Qualified: B.S., Geology, 2003 Connected: California Professional Geologist (PG) 8642 since 2009, Nebraska PG G-0441 since 2018 Professional Summary: Derek has 13 years of experience in environmental case management including: Phase 1 environmental site assessments, subsurface investigations, groundwater monitoring, geologic interpretation, site remediation, coordination with regulatory agencies, interaction with public entities, and management to closure.
Derek Wilken Project Manager/PG
Page 2
Project Manager Petroleum Bulk Terminal | Confidential Client | Van Nuys, CA Planning and coordination of long-term groundwater monitoring and closure negotiations for a bulk terminal. Project efforts included: • Coordination and reporting of long-term groundwater
monitoring and statistical evaluation of data. • Negotiations and coordination with regulatory
agencies regarding case closure. Project Geologist Nuclear Power Plant | Confidential Client | San Onofre, CA Supervision of monitoring well installation activities for groundwater sampling for baseline monitoring at a nuclear power plant. Project efforts included:
• Supervision of monitoring well installations. • Geologic interpretation of soil cuttings. Project Geologist Former Railroad Fuel Storage Yard | Confidential Client | Mentone, CA Performed Phase I investigation of a former railroad fuel storage facility. Project efforts included:
• Review of site historical documents. • Investigation of current site physical conditions and
potential environmental risks. • Interpretation of site conditions and recommendations
for potential assessment activities. Project Manager / Project Geologist Gasoline Service Stations | Confidential Client | Various Cities in California Planning and coordination of environmental investigation activities related to gasoline service station releases. Project efforts included: • Management of numerous gasoline service station
environmental cases in portfolio. • Coordination with regulatory agencies, local
government agencies, and adjacent property owners. • Supervision of assessment activities including: CPT
borings, direct push soil and groundwater borings, soil vapor sampling, and monitoring well installations.
• Health and safety oversight.
• Operation of remediation systems and reporting.
• Geologic interpretation of soil cuttings and CPT logs. • Implementation of a groundwater aquifer pump test. • Preparation of closure requests and coordination with
regulatory agencies.
• Supervision of monitoring well destructions.
Project Geologist Phase I Investigations | Multiple Clients | Various Cities, CA Performed Phase I investigations of various properties including; commercial and industrial properties. Investigations included:
• Review of site historical documents.
• Review of chemical inventories. • Investigation of current site physical conditions and
potential current and historical environmental risks. • Interpretation of site conditions and providing
recommendations for potential assessment activities.
Work history 2007 – present GHD (formerly Conestoga-Rovers &
Associates), Omaha, NE; Irvine, CA
2005 – 2007 Cambria Environmental Technology, Inc. (acquired by Conestoga-Rovers and Associates in 2007), Irvine, CA
Oliver Yan Geologist/Project Coordinator
Page 1
Qualified: BSc Geology and Minor in Anthropology, 2007, University of California, Davis Professional Summary: Oliver has worked in the field of environmental and geologic field consulting since 2008. Oliver has a diverse background in managing and performing environmental site assessment for a variety of petroleum, industrial, and commercial properties throughout Alaska, Washington, and California. Oliver coordinates and performs numerous soil and groundwater investigations involving various sampling techniques and field procedures. Oliver exhibits good proposal development and reporting, effective communication with regulators and clients, good organization, and excellent interpersonal skills.
Project Coordinator/Geologist Retail and Bulk Storage Petroleum Sites | Various Clients | Alaska Oliver acts as project coordinator for various retail and bulk storage petroleum facilities. He performs various site assessment activities, including borehole advancement, soil and groundwater sample collection, soil gas sampling, well installation and decommissioning oversight, and waste coordination with the clients. He develops and prepares various site assessment reports, including work plans, site investigation summary reports, and No Further Action (Site Closure) reports. He implements all health and safety requirements and applies all regulatory directives on all projects. Project Coordinator/Geologist Phase I Environmental Site Assessments | Various Clients | Alaska, Washington, and Idaho Oliver performed Phase I Environmental Site Assessments and Property Transaction Screens to determine the presence of potential Recognized Environmental Conditions prior to sale of various agricultural, commercial, and industrial properties. Assessments included historical records review, property walk-throughs, and document preparation. He reviewed site facility annual compliance for various clients, which involved site visits and interviews with project operations. Staff Geologist Retail and Bulk Storage Petroleum Sites | Various Clients | California Oliver coordinates and implements all logistical aspects of site investigation work including: health and safety, access agreements, notification letters, property relations, local permits, subcontractor coordination (drilling, traffic control, and laboratory), sampling supplies/equipment coordination, and waste handling/manifesting/disposal. Experience with multiple field techniques including: hollow-stem auger, direct push/cone penetrometer, and sonic drilling technologies. Oversight of well installation, soil boring advancement, soil vapor probe installation, subslab vapor probe installation, and remedial activities (site excavation/underground storage tank (UST) removal and remedial system demolition). Proficient in soil logging
(USCS Classification), surface soil sampling, various subsurface soil sampling techniques, grab-groundwater sampling, monitoring well sampling, soil vapor sampling, ambient air sampling, and sensitive receptor/door-to-door surveys. Prepared reports including: Low-Threat/No Further Action Closure reports, Feasibility Studies, Corrective Action Plans, Conceptual Site Models, Subsurface Investigation Reports, Groundwater Monitoring Reports, and various Work Plans. Field Equipment and Fleet Manager California and Washington Offices | October 2011 through May 2013 Oliver managed fleet vehicles for the GHD West Coast offices and managed the field equipment for the Emeryville, California office. Tasks include, but are not limited to: coordination of fleet maintenance, GPS tracking, obtaining all field equipment/sampling supplies, and managed all equipment certifications.
Other related areas of interest Recognized (Certifications/Trainings) • OSHA 40-hour Hazardous Waste Operation and
Emergency Response (HAZWOPER) Worker Training (per 29 CFR 1910.20), June 2008
• OSHA 8-hour HAZWOPER Worker, Refresher, March 2018
• CPR, AED, and Standard First Aid Certified, April 2017
• Loss Prevention Safety Training, July 2008 • Excavation Competent Person Training,
December 2008 • Department of Transportation Hazardous Materials
Transportation (49 CFR 172.704) Training, March 2018
• RCRA Hazardous Waste Management (RCRA 40 CFR Part 265.16) Training, March 2018
• Groundwater Pollution & Hydrology Course, Princeton Groundwater, Inc., March 2013
• 10-hour Occupational Safety & Health Training (Construction Safety & Health), January 2014
• Defensive Driving Training, April 2018
Oliver Yan
Page 2
Work history August 2015 – present
GHD Services, Inc., Anchorage, Alaska
October 2011 – August 2015
GHD Services, Inc. (formerly Conestoga-Rovers & Associates), Emeryville, California
June 2008 – October 2011
Conestoga-Rovers & Associates, Rancho Cordova, California
GHD | Well Decommissioning Report | 620518 (46)
Appendix E ADNR Well Record of Decommissioning Forms
and Original Well Logs
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
Name:
Company:
Address:
(continued): Township: Quarters:
Phone: Datum:
Email:
Yes: No: Well depth (ft bls):
Yes: No: Yes: No: N/A Unknown Static water (ft bls): Flowing artesian? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Bedrock (ft bls): Flood prone site? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Casing type: Well condition? Good: Poor: N/A
Unknown
N/A N/A
If so, PWSID number: ____________________ Well Type Drilled?
Driven?
Jetted?
Well Name or Number:
Capped?
Original Driller's Name:
Screened? Commercial/ Fishery?
Public water system? (See note **)
Single Family Domestic,?
Finish Cased?
Well and Owner Particulars *Well Decommissioner or Contractor
GPS (to 5 places): Latitude:
Owner's name and address:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply. * Note, Do not enter locational information for public water supplies ‐ see note **, below.
Well Record of Decommissioning
AlaskaOfState Department of Natural Resources
Division of Mining, Land & Water
550 w 7th Ave., Suite 1020
Anchorage, AK 99501‐3562
Department of Environmental Conservation
Division of Environmental Health, Drinking Water Program
555 Cordova Street
Anchorage, AK 99501
[email protected]@alaska.gov
Range: Section:
Date of completion: __________/_________/_________________
Former Well Description (Not reqiured if original well log attached).Details of Former Well
Joint DNR DEC by rri 2010
Yes: No: Yes: No: Yes: No: N/A Unknown Diameter (inches): Grouted? Yes: No: N/A
Unknown
Yes: No: Yes: No: Yes: No: N/A Unknown Stickup (ft): Well house? Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
Yes: No: N/A Unknown Yes: No: N/A
Unknown
2) Attach an original water well log, if available. A blank water well log form is available for use if the lithology and well construction details are known but the original water well log is missing.
3) Attach any maintenance or water usage records that may apply to this well and provide an adequate locational description, including maps or sketches. Use additional pages as needed.4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to either DNR or DEC at the addresses listed above.
1) Deliver this form to DNR and DEC within 45 days of decommissioning, as per state regulations 11 AAC 93.140. Please attach schematics and photos to further document the information provided on this form. This is particularly important for public water supply wells and also any other wells that might
impact the public water supply.
# Bags of bentonite in casing? ___________________
Dug?
Well liner present?
Perforated?
Heating / Cooling?
Irrigation/Agricultural?
Excavation Depth (ft)?
Type of fill used?
Screened area filled with gravel?
Pit area mounded?
Reason for well decommissioning:
Signatures ( *** => are required )
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state approved methodes of decommissioning the well.
Casing welded closed?
Excavation and Fill Details
Casing fully removed?
Casing filled with bentonite?
Perforated area filled with gravel?
Excavated pit refilled?
Casing cut below grade?
Decommissioning notes:
Liner (if any) removed?
Plumbing removed from casing?
Well disinfected prior to decommissioning?
Unknown?
_______________ /_______________/___________________________
Decommissioning process
** Public Water System decommissioning may require additional documentation, please contact DEC in this regard.
Attached an original well log?
Well log listed at DNR?
Local authorities notified?
DEC notified of decommissioning?
DNR notified of decommissioning?
Volume of fill (cu ft)?
Electric wiring removed from site?
Borehole refilled?
Joint DNR DEC by rri 2010
MW-1R -42.0
Silty SAND: Dark gray; moist; 75% fine to mediumgrained poorly-graded sand; 25% silt.
SAND with gravel: Olive gray; moist; 80% medium tocoarse grained poorly-graded sand; 20% rounded, finegravel.
SAND with gravel: Olive gray; dry; 70% medium tocoarse grained well-graded sand; 30% rounded tosub-angular, fine to coarse gravel.
SAND with gravel: Olive gray; dry; 70% medium grainedwell-graded sand; 30% rounded, fine to coarse gravel.
SAND with silt: Olive gray; dry; 80% fine to coarsegrained well-graded sand; 10% silt; 10% gravel.
GRAVEL with sand: Dark brown; dry; 60% well-gradedrounded to sub-angular gravel; 40% medium to coarsegrained well-graded sand.
Silty SAND: Dark gray; moist; 75% fine to mediumgrained poorly-graded sand; 25% silt.
MW-1R -25.0
MW-1R - 6.0
SAND with gravel: Dark gray; moist; 80% medium tocoarse grained well-graded sand; 20% fine gravel.
Silty SAND: Olive gray; saturated; 80% fine grainedpoorly-graded sand; 20% silt.
Silty SAND: Olive gray; saturated; 80% fine grainedpoorly-graded sand; 20% silt.
Silty SAND: Olive gray; moist; 80% fine grainedpoorly-graded sand; 20% silt.
Silty SAND: Green gray; dry; 75% fine to mediumgrained poorly-graded sand; 25% silt.
SAND with gravel: Olive gray; moist; 70% fine to coarsegrained well-graded sand; 30% fine gravel.
Silty SAND: Olive gray; moist; 75% fine to mediumgrained poorly-graded sand; 25% silt.
28-May-08
0
SM
SM
SM
SM
0
0
0
0
SM
0
0
12161814
1618
0
SWSM
GW
SW
SW
SW
SP
SMSW
6
10/20 Silica Sand
16
1413
7111519
Bottom of Boring@ 55 fbg
4
Hydrated Bentonite
11
2-inch diam., 0.020Slotted Schedule 40PVC
Concrete
14
101112
10989
10
15
14
17
11161514
888
9
Brian Duggan, P.E. #40693
NA
Nick Greco
GROUND SURFACE ELEVATION
NA
SCREENED INTERVALS
Hollow-Stem Auger
PROJECT NUMBER
NA
8-inch
WELL DEVELOPMENT DATE (YIELD)
44.0 fbg (28-May-08)
REMARKS
DEPTH TO WATER (First Encountered)
Discovery
BORING DIAMETER
NA
DRILLING METHOD
LOGGED BY
Cleared to 4 feet below ground surface using vac-truck
BORING/WELL NAME MW-1R
28-May-08
5
10
15
20
25
30
35
40
45
50
55
PAGE 1 OF 1
JOB/SITE NAME
EXTENT
TOP OF CASING ELEVATION
DEPTH TO WATER (Static)REVIEWED BY
620518
DRILLER
GRAPHIC
LOG
LITHOLOGIC DESCRIPTION
BLOW
COUNTS
SAMPLE ID
PID (ppm)
U.S.C.S.
CONTACT
DEPTH (fbg)
DEPTH
(fbg)
WELL DIAGRAM
CLIENT NAME
4.0
BORING / WELL LOGConestoga-Rovers & Associates2828 North Speer Boulevard, Suite 140Denver, CO 80211Telephone: 303-433-3650Fax: 303-433-3974
DRILLING STARTED
DRILLING COMPLETED
WELL LOG (PID) DENVER C:\DOCUMENTS AND SETTINGS\M
WERNER\DESKTOP\620518 9-4115 (5-08) BORING LOG GINT SPREADSHEET (UPDATED).GPJ DEFAULT.GDT 10/15/08
Former Chevron Service Station 9-4115
11460 Old Seward Highway, Anchorage, AlaskaLOCATION
Chevron Environmental Management Company
40.0
42.0
45.0
47.0
8.0
52.0
37.0
50.0
26.0
10.0
12.0
15.0
17.0
20.0
22.0
25.0
26.5
31.0
35.0
30.0
32.0
27.0
40 to 55 fbg
MW-4R -40.0
WELL LOG (PID) DENVER C:\DOCUMENTS AND SETTINGS\M
WERNER\DESKTOP\620518 9-4115 (5-08) BORING LOG GINT SPREADSHEET (UPDATED).GPJ DEFAULT.GDT 10/15/08
10/20 Silica Sand
1413
7111519
Bottom of Boring@ 55 fbg
MW-4R -21.0
Hydrated Bentonite
2-inch diam., 0.020Slotted Schedule 40PVC
SAND with gravel: Olive gray; dry; 60% medium tocoarse grained poorly-graded sand; 40% fine to coarsegravel.
GRAVEL with sand: Olive gray; dry; 60% fine to coarsewell-graded gravel; 40% coarse sand.
GRAVEL with sand: Olive gray; dry; 60% fine to coarsewell-graded gravel; 40% coarse sand.
GRAVEL with sand: Dark brown; dry; 60% well-gradedrounded to sub-angular gravel; 40% medium to coarsegrained well-graded sand.
Concrete
PAGE 1 OF 1
11460 Old Seward Highway, Anchorage, AlaskaLOCATION
30-May-08
CLIENT NAME
5
10
15
20
25
30
35
40
45
50
55
SAND with gravel: Olive gray; dry; 80% medium grainedpoorly-graded sand; 20% gravel.
30-May-08
11
Former Chevron Service Station 9-4115 DRILLING STARTED
DRILLING COMPLETED
Chevron Environmental Management Company
SW
GW
GW
GWSP
SPSPSP
10
SAND with silt: Olive gray; dry; 90% fine grainedpoorly-graded sand; 10% silt.SAND: Olive gray; dry; 90% fine to medium grainedpoorly-graded sand; 10% silt.SAND: Olive gray; dry; 90% fine to medium grainedpoorly-graded sand; 10% gravel.
SAND with gravel: Olive gray; dry; 80% medium grainedwell-graded sand; 20% gravel.SAND: Olive gray; dry; 90% fine to medium grainedpoorly-graded sand; 10% gravel.
SAND: Olive gray; dry; 95% fine grained poorly-gradedsand; 5% silt.
SAND: Olive gray; moist; 90% fine grainedpoorly-graded sand; 10% silt.Silty SAND: Olive gray; moist; 70% fine grainedpoorly-graded sand; 30% silt.
SP
Silty SAND: Olive gray; saturated; 50% fine to mediumgrained poorly-graded sand; 40% silt; 10% clay.
17
1112
10989
9
SP
14
14
11161514
888
15
0
SP
SPSM
SM
0
0.1
0
0
10
0
6
12161814
161816
4
0
REMARKS
DEPTH TO WATER (First Encountered)
Discovery
BORING DIAMETER
NA
DRILLING METHOD
LOGGED BY
Cleared to 8 feet below ground surface using vac-truck
32.0
43.0 fbg (30-May-08)
37.0
40.0
41.542.0
45.0
47.0
BLOW
COUNTS
TOP OF CASING ELEVATION
DEPTH TO WATER (Static)REVIEWED BY
620518
DRILLER
GRAPHIC
LOG
LITHOLOGIC DESCRIPTION WELL DIAGRAM
EXTENT
SAMPLE ID
PID (ppm)
U.S.C.S.
CONTACT
DEPTH (fbg)
DEPTH
(fbg)
Conestoga-Rovers & Associates2828 North Speer Boulevard, Suite 140Denver, CO 80211Telephone: 303-433-3650Fax: 303-433-3974
BORING / WELL LOG
SCREENED INTERVALS
NA
Nick Greco
GROUND SURFACE ELEVATION
WELL DEVELOPMENT DATE (YIELD)
Brian Duggan, P.E. #40693
Hollow-Stem Auger
PROJECT NUMBER
NA
8-inch
31.5
NA
35.0
20.0
8.0
10.0
12.0
15.0
17.0
21.021.522.0
25.0
27.0
30.0
16.5
BORING/WELL NAME
JOB/SITE NAME
MW-4R
40 to 55 fbg
GRAVEL with sand: Dark gray; dry; 45% sub-rounded torounded gravel; 45% medium to coarse grainedwell-graded sand; 10% silt.
WELL LOG (PID) DENVER C:\DOCUMENTS AND SETTINGS\M
WERNER\DESKTOP\620518 9-4115 (5-08) BORING LOG GINT SPREADSHEET (UPDATED).GPJ DEFAULT.GDT 10/15/08
Silty SAND: Olive brown; dry; 75% fine to mediumgrained poorly-graded sand; 25% silt.
Silty SAND: Olive brown; dry; 60% fine grainedpoorly-graded sand; 40% silt.
Silty SAND: Olive brown; dry; 60% fine grainedpoorly-graded sand; 40% silt.
Silty SAND: Olive brown; dry; 85% fine to mediumgrained poorly-graded sand; 15% silt.
Silty SAND: Dark gray; saturated; 75% fine to mediumgrained poorly-graded sand; 25% silt.
Silty SAND: Olive brown; dry; 85% fine to mediumgrained poorly-graded sand; 15% silt.
SAND: Olive brown; dry; 80% medium grainedpoorly-graded sand; 10% fine rounded gravel; 10% silt.
GRAVEL with sand: Dark brown; dry; 50% roundedgravel; 50% coarse grained well-graded sand.
GRAVEL with sand: Dark brown; dry; 60% well-gradedrounded to sub-angular gravel; 40% medium to coarsegrained well-graded sand.
MW-11 R -40.0
Silty SAND: Olive brown; dry; 75% fine to mediumgrained poorly-graded sand; 25% silt.
Silty SAND: Dark gray; saturated; 75% fine grainedpoorly-graded sand; 25% silt.
Silty SAND: Dark gray; saturated; 75% fine to mediumgrained poorly-graded sand; 25% silt.
MW-11 R -20.0 SP
8
97
89913
12
8
12
10
9999
787
8
0
SPSM
SM
SM
SM
SM
SM
10
0
9
0
0
0
0
0
221213
SM
GW
GW
9
GW
19
1413
8121216
11
16
SP
Bottom of Boring@ 55 fbg
Concrete
Hydrated Bentonite
10/20 Silica Sand
2-inch diam., 0.020Slotted Schedule 40PVC
9
12
REVIEWED BY
Discovery
8-inch
NADEPTH TO WATER (Static)
PROJECT NUMBER 620518
DRILLER
GRAPHIC
LOG
LITHOLOGIC DESCRIPTION WELL DIAGRAM
EXTENT
BLOW
COUNTS
TOP OF CASING ELEVATION
NA
DRILLING METHOD
LOGGED BY
Cleared to 8 feet below ground surface using vac-truck
NA
U.S.C.S.
Nick Greco
GROUND SURFACE ELEVATION
WELL DEVELOPMENT DATE (YIELD)
NA
Brian Duggan, P.E. #40693
SCREENED INTERVALS
Hollow-Stem Auger
LOCATION 29-May-08
5
10
15
20
25
30
35
40
45
50
55
PAGE 1 OF 1
29-May-08
SAMPLE ID
MW-11R
11460 Old Seward Highway, Anchorage, Alaska
Former Chevron Service Station 9-4115
CLIENT NAME Chevron Environmental Management Company
DRILLING COMPLETED
DRILLING STARTED
Conestoga-Rovers & Associates2828 North Speer Boulevard, Suite 140Denver, CO 80211Telephone: 303-433-3650Fax: 303-433-3974
BORING / WELL LOG
DEPTH TO WATER (First Encountered)
CONTACT
DEPTH (fbg)
DEPTH
(fbg)
JOB/SITE NAME
BORING/WELL NAME
PID (ppm)
25.0
10.011.012.0
15.0
17.0
BORING DIAMETER
40.0
26.027.0
30.0
32.0
35.0
37.0
20.0
8.0
22.0
REMARKS
42.0
43.0 fbg (29-May-08)
45.0
47.0
50.051.052.0
40 to 55 fbg
0.1
0.0
7.2
0.1
0.2
well graded SAND with gravel: fine to coarsegrained, subangular, olive gray, moist; fine tocoarse grained gravel.
well graded SAND with gravel: fine to coarsegrained, subangular to subrounded, olive gray,moist; fine to coarse grained gravel.
well graded SAND: fine to medium grained,subrounded, olive gray, moist.
poorly graded SAND: fine grained,subrounded, olive gray, moist.
- lenses of oxidation at 21.5ft BGS
poorly graded SAND: fine grained,subrounded, olive gray, moist.
P-gravel
BentoniteChipsSch. 40 PVC
8.00
10.00
12.00
15.00
17.00
20.00
22.00
25.00
27.00
(OVERBURDEN) Page 1 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
DE
PT
H (
ft)
This log should not be used separately from the original report.
PP
(ts
f)
2
4
6
8
10
12
14
16
18
20
22
24
26
28
DEPTHft BGS
MW-15RR
STRATIGRAPHIC AND INSTRUMENTATION LOG
DATE COMPLETED: October 8, 2010
DRILLING METHOD: Hollow-Stem Auger
FIELD PERSONNEL: S. Holtz/N. Taylor
REVIEWED BY: Brian Duggan
10/8/2010
LABORATORY ANALYSIS
PROJECT NAME: 9-4115
PROJECT NUMBER: 620518
CLIENT: Chevron Environmental Management Company
LOCATION: 11460 Old Seward Highway, Anchorage, Alaska
DRILLER: Discovery Drilling
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
NOTES:
STATIC WATER LEVEL 10/11/2010WATER FOUND
OV
ER
BU
RD
EN
LO
G 6
2051
8.G
PJ
CR
A_C
OR
P.G
DT
12/
21/1
0
WELL CONSTRUCTIONDEPTHft BGS
MW-15R-
15.0
0.1
0.1
0.4
0.1
0.1
poorly graded SAND with silt: fine grained,subrounded, olive gray, moist.
poorly graded SAND with silt: fine grained,subrounded, olive gray, moist.
SILT with sand: fine grained, rounded, olivegray, wet.
SILT with sand: fine grained, rounded, olivegray, wet.
SILT: olive gray, wet.
SILT: olive gray, wet.
END OF BOREHOLE @ 52.0ft BGS
10/20 SilicaSand
0.020" Sch.40 PVC
30.00
32.00
35.00
37.00
38.00
40.00
42.00
45.00
47.00
50.00
52.00
(OVERBURDEN) Page 2 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
DE
PT
H (
ft)
This log should not be used separately from the original report.
PP
(ts
f)
32
34
36
38
40
42
44
46
48
50
52
54
56
58
DEPTHft BGS
MW-15RR
STRATIGRAPHIC AND INSTRUMENTATION LOG
DATE COMPLETED: October 8, 2010
DRILLING METHOD: Hollow-Stem Auger
FIELD PERSONNEL: S. Holtz/N. Taylor
REVIEWED BY: Brian Duggan
10/8/2010
LABORATORY ANALYSIS
PROJECT NAME: 9-4115
PROJECT NUMBER: 620518
CLIENT: Chevron Environmental Management Company
LOCATION: 11460 Old Seward Highway, Anchorage, Alaska
DRILLER: Discovery Drilling
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
NOTES:
STATIC WATER LEVEL 10/11/2010WATER FOUND
OV
ER
BU
RD
EN
LO
G 6
2051
8.G
PJ
CR
A_C
OR
P.G
DT
12/
21/1
0
WELL CONSTRUCTIONDEPTHft BGS
MW-15R-
38.0
SAND with gravel: Olive gray; dry; 60% coarse grainedpoorly-graded sand; 30% fine to coarse gravel; 10% silt.
Silty SAND: Olive gray; saturated; 65% fine grainedpoorly-graded sand; 35% silt.
Silty SAND: Olive gray; saturated; 80% coarse grainedpoorly-graded sand; 20% silt.
Silty SAND: Olive gray; moist; 80% coarse grainedpoorly-graded sand; 20% silt.
Silty SAND: Olive gray; dry; 80% coarse grainedpoorly-graded sand; 10% gravel; 10% silt.
Silty SAND: Olive gray; dry; 80% coarse grainedpoorly-graded sand; 20% silt.
SAND with gravel: Olive gray; dry; 60% coarse grainedpoorly-graded sand; 30% fine to coarse gravel; 10% silt.
GRAVEL with sand: Olive gray; dry; 60% well-gradedfine to coarse gravel; 40% coarse grained poorly-gradedsand.
GRAVEL with sand: Olive gray; dry; 60% well-gradedfine to coarse gravel; 40% coarse well-graded sand.
GRAVEL with sand: Dark brown; dry; 60% well-gradedrounded to sub-angular gravel; 40% medium to coarsegrained well-graded sand.
MW-11 R -40.0
Silty SAND: Olive gray; dry; 80% coarse grainedpoorly-graded sand; 20% silt.
Silty SAND: Olive gray; saturated; 65% fine grainedpoorly-graded sand; 35% silt.Silty SAND: Olive gray; saturated; 80% medium grainedpoorly-graded sand; 20% silt.
CLAY and SILT: Green gray; saturated; 50% silt; 50%clay; low plasticity.
Silty SAND: Olive gray; saturated; 65% fine grainedpoorly-graded sand; 35% silt.
MW-16 -20.0
MW-16 -15.0
WELL LOG (PID) DENVER C:\DOCUMENTS AND SETTINGS\M
WERNER\DESKTOP\620518 9-4115 (5-08) BORING LOG GINT SPREADSHEET (UPDATED).GPJ DEFAULT.GDT 10/15/08
10
7
151516
89112
0.3
7
0
16
6666
667
5
SP
GW
GW
GW
SP
SPSM
SM
SP
7
SP
10
SPSP
SPML
0.1
0
0
0
0
SP
9
10/20 Silica Sand
Hydrated Bentonite
5
1012
7101315
47
2-inch diam., 0.020Slotted Schedule 40PVC
12
51012
5101519
Bottom of Boring@ 57 fbg
Concrete
13
Brian Duggan, P.E. #40693
SCREENED INTERVALS
Hollow-Stem Auger
PROJECT NUMBER
NA
WELL DEVELOPMENT DATE (YIELD)
8-inch
GROUND SURFACE ELEVATION
TOP OF CASING ELEVATION
DEPTH TO WATER (Static)REVIEWED BY
620518
DRILLER
GRAPHIC
LOG
LITHOLOGIC DESCRIPTION
Cleared to 8 feet below ground surface using vac-truckREMARKS
45.0 fbg (29-May-08)DEPTH TO WATER (First Encountered)
Discovery
BORING DIAMETER
NA
NA
LOGGED BY
EXTENT
NA
Nick Greco
DRILLING METHOD
29-May-08
5
10
15
20
25
30
35
40
45
50
55
PAGE 1 OF 1
29-May-08
WELL DIAGRAM
LOCATION 11460 Old Seward Highway, Anchorage, Alaska
Former Chevron Service Station 9-4115
CLIENT NAME Chevron Environmental Management Company
DRILLING COMPLETED
DRILLING STARTED
Conestoga-Rovers & Associates2828 North Speer Boulevard, Suite 140Denver, CO 80211Telephone: 303-433-3650Fax: 303-433-3974
BORING / WELL LOG
BLOW
COUNTS
SAMPLE ID
PID (ppm)
U.S.C.S.
CONTACT
DEPTH (fbg)
DEPTH
(fbg)
MW-16BORING/WELL NAME
JOB/SITE NAME
15.0
32.0
8.0
12.0
17.0
20.0
22.0
25.026.027.0
30.0
10.0
35.0
51.5
37.0
40.0
42.0
45.045.5
50.0
52.0
55.056.057.0
47.0
40 to 55 fbg
0.0
0.3
0.2
0.2
0.4
well graded SAND with gravel: fine to coarsegrained, subrounded, olive gray, dry; fine tocoarse grained gravel.
well graded SAND with gravel: medium tocoarse grained, subangular to subrounded,olive gray, moist; fine to coarse grained gravel.
well graded SAND with gravel: medium tocoarse grained, subangular to subrounded,olive gray, moist; fine to coarse grained gravel.
well graded SAND with gravel: medium tocoarse grained, subrounded, olive gray, moist;fine grained gravel.
well graded SAND with gravel: medium tocoarse grained,subangular to subrounded,olive gray, moist; fine to coarse grained gravel.
P-gravel
BentoniteChipsSch. 40 PVC
7.00
10.00
12.00
15.00
17.00
20.00
22.00
25.00
27.00
(OVERBURDEN) Page 1 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
DE
PT
H (
ft)
This log should not be used separately from the original report.
PP
(ts
f)
2
4
6
8
10
12
14
16
18
20
22
24
26
28
DEPTHft BGS
MW-17
STRATIGRAPHIC AND INSTRUMENTATION LOG
DATE COMPLETED: October 6, 2010
DRILLING METHOD: Hollow-Stem Auger
FIELD PERSONNEL: S. Holtz/N. Taylor
REVIEWED BY: Brian Duggan
10/6/2010
LABORATORY ANALYSIS
PROJECT NAME: 9-4115
PROJECT NUMBER: 620518
CLIENT: Chevron Environmental Management Company
LOCATION: 11460 Old Seward Highway, Anchorage, Alaska
DRILLER: Discovery Drilling
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
NOTES:
STATIC WATER LEVEL 10/11/2010WATER FOUND
OV
ER
BU
RD
EN
LO
G 6
2051
8.G
PJ
CR
A_C
OR
P.G
DT
12/
21/1
0
WELL CONSTRUCTIONDEPTHft BGS
0.2
0.4
0.4
0.1
0.0
poorly graded SAND: fine grained,subrounded, olive gray, moist.
poorly graded SAND: fine grained,subrounded, olive gray, moist.
poorly graded SAND: fine grained,subrounded, olive gray, moist.
poorly graded SAND: fine grained,subrounded, olive gray, moist.
poorly graded SAND with silt: fine grained,subrounded, olive gray, wet.
silty SAND: fine grained, subrounded, olivegray, wet.
SILT with sand: fine grained, subrounded,dark gray, wet.
END OF BOREHOLE @ 57.0ft BGS
10/20 SilicaSand
0.020" Sch.40 PVC
30.00
32.00
35.00
37.00
40.00
42.00
45.00
47.00
50.00
52.00
55.0055.50
57.00
(OVERBURDEN) Page 2 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
DE
PT
H (
ft)
This log should not be used separately from the original report.
PP
(ts
f)
32
34
36
38
40
42
44
46
48
50
52
54
56
58
DEPTHft BGS
MW-17
STRATIGRAPHIC AND INSTRUMENTATION LOG
DATE COMPLETED: October 6, 2010
DRILLING METHOD: Hollow-Stem Auger
FIELD PERSONNEL: S. Holtz/N. Taylor
REVIEWED BY: Brian Duggan
10/6/2010
LABORATORY ANALYSIS
PROJECT NAME: 9-4115
PROJECT NUMBER: 620518
CLIENT: Chevron Environmental Management Company
LOCATION: 11460 Old Seward Highway, Anchorage, Alaska
DRILLER: Discovery Drilling
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
NOTES:
STATIC WATER LEVEL 10/11/2010WATER FOUND
OV
ER
BU
RD
EN
LO
G 6
2051
8.G
PJ
CR
A_C
OR
P.G
DT
12/
21/1
0
WELL CONSTRUCTIONDEPTHft BGS
MW-17-
35.0
MW-17-
45.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
25
75
80
100
100
891010
12111311
10788
591112
5579
SM-SAND, with silt, with coarse gravel, withcobble, compact, fine to medium grained, poorlygraded, moist
- large cobble at 3.0ft BGS
SP-SAND, trace silt, fine to medium grained,poorly graded, brown to black, moist
- with cobble, compact, brown at 10.0ft BGS
SM-SAND, trace to with silt, with cobble, tracecoarse gravel, compact, fine to coarse grained,well graded, brown to dark brown, moist
SP-SAND, trace silt, trace fine to coarse gravel,compact, medium grained, poorly graded, brownto light brown, moist
- medium to coarse grained at 25.0ft BGS
- trace coarse gravel at 30.0ft BGS
PEA GRAVEL
2" PVC WELLCASING
BENTONITECHIPS
6" BOREHOLE
4.50
15.00
20.00
PID
(pp
m)
(OVERBURDEN) Page 1 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
NU
MB
ER
'N' V
ALU
E
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
DEPTHft BGS
MW-18
WATER FOUND
DATE COMPLETED: June 3, 2015
DRILLING METHOD: HOLLOW STEM AUGER/VAC
FIELD PERSONNEL: T. ECHTERMEYER/N. HINSPERGER
STRATIGRAPHIC AND INSTRUMENTATION LOG
CHEMICAL ANALYSIS
PROJECT NAME: CHEVRON 94115
PROJECT NUMBER: 620518
CLIENT: CHEVRON EMC
LOCATION: 11460 OLD SEWARD HWY, ANCHORAGE, ALASKA
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
MEASURING POINT ELEVATIONS MAY CHANGE; REFER TO CURRENT ELEVATION TABLENOTES:
OV
ER
BU
RD
EN
LO
G 6
2051
8-W
I.G
PJ
CR
A_C
OR
P.G
DT
12/
8/1
5
MONITORING WELLDEPTHft BGS
1AV
2AV
3SS
4SS
5SS
6SS
7SS
0.0
2.4
0.0
0.0
100
100
100
100
791212
8121316
8121213
8121213
- trace fine to medium gravel at 35.0ft BGS
- brown to gray, moist to wet, little oxidation at41.0ft BGS
- gray, wet at 45.0ft BGS
- wet, oxidation at 51.0ft BGS
END OF BOREHOLE @ 52.0ft BGS
2" PVC WELLSCREEN
SAND PACK
WELL DETAILSScreened interval: 37.00 to 52.00ft BGSLength: 15ftDiameter: 2inSlot Size: 0.010Material: PVCSeal: 2.00 to 35.00ft BGSMaterial: BENTONITE CHIPSSand Pack: 35.00 to 52.00ft BGSMaterial: SAND
52.00
PID
(pp
m)
(OVERBURDEN) Page 2 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
NU
MB
ER
'N' V
ALU
E
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
DEPTHft BGS
MW-18
WATER FOUND
DATE COMPLETED: June 3, 2015
DRILLING METHOD: HOLLOW STEM AUGER/VAC
FIELD PERSONNEL: T. ECHTERMEYER/N. HINSPERGER
STRATIGRAPHIC AND INSTRUMENTATION LOG
CHEMICAL ANALYSIS
PROJECT NAME: CHEVRON 94115
PROJECT NUMBER: 620518
CLIENT: CHEVRON EMC
LOCATION: 11460 OLD SEWARD HWY, ANCHORAGE, ALASKA
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
MEASURING POINT ELEVATIONS MAY CHANGE; REFER TO CURRENT ELEVATION TABLENOTES:
OV
ER
BU
RD
EN
LO
G 6
2051
8-W
I.G
PJ
CR
A_C
OR
P.G
DT
12/
8/1
5
MONITORING WELLDEPTHft BGS
8SS
42' -0019SS
10SS
11SS
0.0
0.0
0.0
0.0
0.0
0.0
0.0
100
100
75
100
100
100
100
8121314
50505050
6688
5688
58811
SM-SAND, with silt, with cobble, with rootlets,loose, fine grained, poorly graded, brown to lightbrown
SP-SAND, trace silt, trace angular cobble, loose,medium grained, poorly graded, brown to black,moist
- with cobble, compact at 11.0ft BGS
- large cobble at 16.0ft BGS- dense, coarse grained, brown at 16.4ft BGS
SM-SAND, with silt, trace coarse gravel, finegrained, poorly graded, light brown, moist
SP-SAND, trace silt, compact, medium to coarsegrained, poorly graded, dark brown, moist
- coarse grained at 31.1ft BGS
PEA GRAVEL
2" PVC WELLCASING
BENTONITECHIPS
6" BOREHOLE
5.00
20.00
20.90
PID
(pp
m)
(OVERBURDEN) Page 1 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
NU
MB
ER
'N' V
ALU
E
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
DEPTHft BGS
MW-19
WATER FOUND
DATE COMPLETED: June 4, 2015
DRILLING METHOD: HOLLOW STEM AUGER/VAC
FIELD PERSONNEL: T. ECHTERMEYER/N. HINSPERGER
STRATIGRAPHIC AND INSTRUMENTATION LOG
CHEMICAL ANALYSIS
PROJECT NAME: CHEVRON 94115
PROJECT NUMBER: 620518
CLIENT: CHEVRON EMC
LOCATION: 11460 OLD SEWARD HWY, ANCHORAGE, ALASKA
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
MEASURING POINT ELEVATIONS MAY CHANGE; REFER TO CURRENT ELEVATION TABLENOTES:
OV
ER
BU
RD
EN
LO
G 6
2051
8-W
I.G
PJ
CR
A_C
OR
P.G
DT
12/
8/1
5
MONITORING WELLDEPTHft BGS
1AV
2AV
3SS
4SS
5SS
6SS
7SS
0.0
0.0
0.0
0.0
100
100
100
100
69912
591113
5779
221012
- medium to coarse grained, light brown at 36.2ftBGS
- moist to wet at 40.0ft BGS
SW-SAND, trace silt, trace medium gravel,compact, fine to coarse grained, well graded,dark brown, moist to wet
- wet at 45.0ft BGS
- wet at 50.0ft BGS
END OF BOREHOLE @ 52.0ft BGS
2" PVC WELLSCREEN
SAND PACK
WELL DETAILSScreened interval: 37.00 to 52.00ft BGSLength: 15ftDiameter: 2inSlot Size: 0.010Material: PVCSeal: 2.00 to 35.00ft BGSMaterial: BENTONITE CHIPSSand Pack: 35.00 to 52.00ft BGSMaterial: SAND
41.50
52.00
PID
(pp
m)
(OVERBURDEN) Page 2 of 2
INT
ER
VA
L
SAMPLE
RE
C (
%)
NU
MB
ER
'N' V
ALU
E
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
DEPTHft BGS
MW-19
WATER FOUND
DATE COMPLETED: June 4, 2015
DRILLING METHOD: HOLLOW STEM AUGER/VAC
FIELD PERSONNEL: T. ECHTERMEYER/N. HINSPERGER
STRATIGRAPHIC AND INSTRUMENTATION LOG
CHEMICAL ANALYSIS
PROJECT NAME: CHEVRON 94115
PROJECT NUMBER: 620518
CLIENT: CHEVRON EMC
LOCATION: 11460 OLD SEWARD HWY, ANCHORAGE, ALASKA
HOLE DESIGNATION:
STRATIGRAPHIC DESCRIPTION & REMARKS
MEASURING POINT ELEVATIONS MAY CHANGE; REFER TO CURRENT ELEVATION TABLENOTES:
OV
ER
BU
RD
EN
LO
G 6
2051
8-W
I.G
PJ
CR
A_C
OR
P.G
DT
12/
8/1
5
MONITORING WELLDEPTHft BGS
8SS
41.5'-002
9SS
10SS
11SS
GHD | Well Decommissioning Report | 620518 (46)
Appendix F GHD Field Notes
Siobhan Pritchard [email protected] 720.974.0963