HomeMy WebLinkAboutSKY RIDGE LT 9DL, Form 24?'
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WATER WELL DRILLERS LOG
Drilling Co. /'/� �� �' sT/A)c t21LL
Driller �ay
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DO NOT FIILL IN
Well No. �� 7
Permit No.
Certificate No.
Area
Well Owner 1-_, AJP, l�f r tr' Use of well
Location (address
of: Township, Range,'& Section, if known; or distance main
road
Size of casing Depth of Hole feet Cased to feet
Static water level rod ft, (absv%,) (below) land surface. Finish of well (check one)
Open end ( )( ); Screen ( ); Perforated ( ).
Describe screen or perforations
Well pumping test at /^ 2� gallons per
of drawdown from static level.
or 0 hours with ft.
Was casing sailar sealed -with cement grout !Y
WELL LOG
Depth in feet from Give details of formations penetrated, size of material, color,
ground surface and hardness.
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MUf-'449'UFALfi-Y-0f ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT907-343-7904
On -Site Water and Wastevvater Section Fax: 3413-7991
Re
Well Decommissioning Log
Legal Address:
Subdivision oy- Q LbU Block Lot 01
T R Section Lot
On -site Water & Wastewater Section certified contractor performing the well decommissioning:
Name:
c �,, ,Wf6� Signature:
Compa y:�
1�2
Well decommissioning date Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ C.
Location: Use the space below to provide a drawing of the property showing the following items:
• North arrow
• Decommissioned well location
• Location of other water wells on the property
• Two separate swing -tie distances for each well shown on the drawing
Note: The swing -tie distances shall be measured from either permanent structures or the property comers.
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G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc
