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by DEPT. OF L'=ALTII &
ENVIRONMENTAL F.OT_CTION
DOC Co. Cba
SULLIVAN WATER WELLS FEB 51980
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 RECEIVED
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION'
DATE. • Started Ended
PERMIT NUMBER
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MISCL. INFORMATION:
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
DRILLER'S NAME �
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DRILLER'S NAME �
r•7 !_I r -a I f- I F' C-4 L_ I T'-: 0 F F-i"i_'� F-1 ID F' ti ID E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, AK. 99501.
264-4720
WELL F'EF'h•1 I T
PERMIT NO. C 790592
APPLICANT JOE SENYTEF: PO BOX 272 CHUGIAK: 6ES-2759
LOCATION ELEORNA ST
LEGAL LOT 1 BLK 2 DEBORA SUE; LOT SIZE 21780 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
:100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER IN•=TALLATION.
F E7 FQ Ul 3" T E>1 F" I F? E'S PEr`EZP1E E7 F2 _-:L, j_`__+ So _.
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES.
r
SIGNED:__..---------_-----
APPLICANT/1?OE, SEWETER.
ISSUED