HomeMy WebLinkAboutMOOREHAND #3 LT 18Name:
Company:
Address:
(continued):Township:Quarters:
Phone:Datum:
Email:
Yes: No:Well depth (ft bls):
Well Type Yes:No:Finish Cased Yes: No:
N/A
Unknown SWL (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
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:Yes: No:
N/A
Unknown Yes: No:
N/A
Unknown
Yes:Yes: No:
N/A
Unknown Yes: No:
N/A
Unknown
Yes: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
4) This form is under development and is subject to change. Please submit suggestions for changes or improvements to the addresses listed above.
1) Submit this form to DNR and DEC (see contact info at top of form) within 45 days of decommissioning, as per 11 AAC 93.140 and 18 AAC 80.015.Please attach schematics and photos to further document the information provided
on this form. This is particularly important for public water system wells and also
any other wells that might impact the public water system.
Driven
Jetted
Dug
Well disinfected prior to decommissioning
Borehole refilled Placement method
** Public Water System decommissioning may requires additional documentation, please contact DEC in this regard.
If so, PWSID number:
AWWA A100 Method
Alaska BMPs Method
Other Method (describe below)
No:
No:
No:
2) Attach an original water well log. If not available, a blank water well log form is available at http://dnr.alaska.gov/mlw/forms/#waterother if well details are known.
3) Attach maintenance or water usage records and provide an adequate locational description, including maps or sketches. Use additional pages as needed.
Well Decommissioner or Contractor
GPS to 5 places: Latitude:
Owner's name and address:
Well Name or AK WELTS Number:
Well location ‐ Street & number:
Well location ‐ Subdivision, Lot & Block:
Meridian:
Longitude:
Range: Section:
This form is intended to convey information regarding the decommisioning of a water well as required by both DEC and DNR. Add additional datasheets (e.g., site schematic and photos) as necessary.
Please check all boxes that apply and provide all requested information. Do not check boxes that do not apply.
Well Record of Decommissioning (version 2021)
Reason for well decommissioning:
*** Signatures required
Owner***:
Date: _______________ /_______________/___________________________
Decommisioner / Contractor***:
Date:
Include notes regarding any deviations from state
approved methods of decommissioning as
described in 18 AAC 80.015e.
Casing welded closed Excavation and Fill Details
Casing fully removed
Casing filled with bentonite
Perforations filled with gravel
Excavated pit refilled
Casing cut below grade
Well and Owner Details *
_______________ /_______________/___________________________
Decommissioning process
Alaska
Of
State 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
dec.eh.drinkingwater.reports@alaska.govdnr.water.reports@alaska.gov
Former Well Description (Not required if original well log attached).Details of Former Well
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
http://dec.alaska.gov/eh/dw/regulations/
Capped
Screened
Original Driller's Name:
_________________________________# Bags of bentonite in casing
Date of completion: __________/_________/_________________
Unknown Well liner present
Commercial/ Fishery
Perforated
Public water system? (See note **)
Single Family Domestic
Heating / Cooling
Irrigation/Agricultural
Excavation Depth (ft)
Type of fill used
Screen filled with gravel
Pit area mounded
Decommissioning notes:
Liner (if any) removed
Plumbing removed from casing
Drilled
Joint DNR DEC by rri 2010; modified 2020
David Kranich
Norther Utility Services LLC
Box 233368 anchorage, AK 99523
907-222-4084
Dave@nusalaska.com
Unified Alaskan Utilities Box 233368 Anchorage, AK 99523
9131 Elim st Anchorage, AK
Moorehand #3 lot 18
ADL57209
X
211229 X X
X
X
X
X
220
55
na
steel
8"
1.5
X
X
X
X
X
1973
No Longer used
X
X
Non Bridging Fill
10 ft
Bentonite and Crush rock
38
76.8
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
David Kranich Northern Utility Services
10/14/2025
David Kranich Unified Alaskan Utilities
10/14/2025
Well Log # 12977
Moorehand 3 18
David Kranich
Noirthern Utility Services LLC
9/3/2025 X
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
Alaska Hydrologic Survey
WATER WELL LOG Revised 08/18/2016
Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______
City/Borough Subdivision Block Lot Property Owner Name & Address
Well location: Latitude Longitude
Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4
BOREHOLE DATA: (from ground surface)
Suggest T.M. Hanna’s hydrogeologic classification system*
https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD
Depth
From To
Drilling method: Air rotary, Cable tool, Other
Well use: Public supply, Domestic, Reinjection, Hydrofracking
Commercial, Observation/Monitoring, Test/Exploratory, Cooling,
Irrigation/Agriculture, Grounding, Recharge/Aquifer Storage,
Heating, Geothermal Exploration, Other
Fluids used:
Depth of hole: __________ ft Casing stickup: ___________ft
Casing type: __________ Casing thickness: _________ inches
Casing diameter: _________ inches Casing depth: __________ ft
Liner type: _________ Depth: _____ ft Diameter: _____inches
Note:
Well intake opening type: Open end, Open hole, Other
Screen type: _________, Screen mesh size: ____________
Screen start: ________ ft, Screen stop:________ ft, Perforated Yes No
Perforation description: Perf from: ________ ft, Perf
to: _______ft, Perf from: ________ ft, Perf to: ________ ft
Gravel packed Yes No Gravel start: ______ ft , Gravel stop:______ ft
Note:
Static water (from top of casing): _______ ft on____/____/_____ Artesian well
Pumping level & yield: ______ feet after _____ hours at _____ gpm
Method of testing:__________________________________________
Development method:______________ Duration: ____________
Recovery rate: _________ gpm
Grout type: _________________ Volume __________________
Depth: From ___________________ft, To ___________________ft
Final pump intake depth: __________ ft Model: _______________
Pump size: _____________ hp Brand name: __________________
Include description or sketch of well location (include road names,
buildings, etc.):
Was well disinfected upon completion? Yes No
Method of disinfection:
Was water quality tested? Yes No
Water quality parameters tested:
Well driller name: ..................................................................................
Company name: ...................................................................................
Mailing address: ....................................................................................
City: __________________________ State: AK Zip: ___________
Phone number: (________) ________- ______
Driller’s signature:
Date: ______/______/_________
Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require
that a copy of this well log be submitted to the Development Services Department/City
within 30 days of well completion.
City Permit Number: _____________________________
Date of Issue: _____/____/_________
Parcel Identification Number: ______-_______-________
*Guide for Using the Hydrogeologic Classification System for Logging
Water Well Boreholes by Thomas M. Hanna NGWA Press
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
copy of the well log be submitted to the Department of Natural
Resources within 45 days of well completion. Well logs may
be submitted using the online well log reporting system
available at:
https://dnr.alaska.gov/welts/
OR email electronic well logs to
dnr.water.reports@alaska.gov
North
003W SE
Municipality of Anchorage
SE
MOOREHEAD 3
n
SW
ALPAT CO ,
12977
220
L18
n
S
WILSON WELL DRILLING
n
n
n
012N SE8