HomeMy WebLinkAboutKWIK LOG BLK 3 LT 7
APR -18-2016 08:41A FROM: 70:343'7997 P.1'1
Community Development 0epartment
Onsite Water and Wastewater Program
4700 Elmore St. " P.O. Box 196650 Anchorage, AK 9D51941650 httplUwww.munt.ofWonaAe • 1907} 343-7904
Well Decommissioning Log
Legaldivsion Address:
Subdivision V\t�Ii tR 1-"o" Block ,3 Lot 7
41
T R Section Lot
011 water & Wastewater Program certified contractor performing the well deoannissioning:
N&me: Ty
J „lq signature:
i
Company: �Gf .A 0 �.
Well dewmmkaloning date ' i '' raeu od of decammissiomhg: AMC 15.55.0601-1 a. ❑ b. ❑ 0,91
Laratlon: Use the space below to Provide a drawing of the property showing the folloWng hems;
_ • NoM arrow
• Oawmnriaaloned well,
Other water webs on the property,
Two "pends Swing -tie distances for Gash welt shown on that draNring,
Note: The swig la distances shall be measured from either parmaitent structures or the property content
,
SNA T AN L4h1 Er
8�� 4D' WO ril. g2.90
t Y.
o:
° I
err --tis"!+r
iM. cam �•� s.�
rem 'sI
,
ry
4
!
=P
3
�
"I
ts,.�eumrr...vcwae
uamwu
3
p1y�;w.snuasu.�--n
ry N
t:AR N 1993
RECEIVED
k
5,
81 9a' 90 1f.
®E50—__4_
I)EPAiUE~4/i:NT OF HATUI~ RESO~TRCES
DIVISION OF GEOLOGICAL AND GEOPHYSICAL SURVgYS
WATES. WELL RECORD
LOCATION OF WELL
BOROUGH
SUBDIVISION
DIRECTIONS:
I ~O BLOCK
.D
MEASURING POINT: []top of casing
[~ground surface []other:
BOREHOLE DATA:
Material type and color
Depth
RECEIVE[)
Dept. Health
REMARKS:
CONTRACTOR INFORMATION:
' '~-',:'.'-"/3. i !. . i. i ' : .: ~
Regis%ered Business Name
Signature of ~uthor±zed Representative
Date
WELL DEPTH
of
COm',ET 'ON
STATIC WATER LEVEL: ~2.~ ft. Date
METHOD OF DRILLING: [-]air zotary
E]cable too.l E] other:
USE OF WELL: I_~domestic ~J. rrigation ~monitor
[]pul>nc supp].y ~_] other:
CASING: S t ick-up._ ~_O__%}_.f t . Diam: in
WELL INTAKE: ~-] open eP.d
~ perforated
Depths of openings; to
~screened
~open hole
ft
SCREEN TYPE: ................. Diam:
Slot/Mesh Size: Length:
Set Between and ft
in
GRAVEL PACK TYPE:
VoJ. ume used:
Depth to top:
GROUT TYPE: Volumel
Depth: from ft to ft
DEVELOPMENT METHOD:
Duratlon:__~ hooky%
PUt, PING I,EVEL kND YIELD:
....... ft after__.~_hr$ pumping.
gpm
PUMP INTAKE DEPTIt: ____ft Horsepower:
Date Pump Inst:alled -
WATEP, CHEMIS'.['RY S,MflPLE TAKEN? [] yes []no
Well disinfected__,ji{o_n cq,~pletion? ~yes ~no
PLEASE MAIL WHI:F£ COPY OF LOG WITHIN 45
DA YS TO:
DGGS
PO BOX 77-2.126
EAGLE RIVER, AK. 99577
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW930036
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:CLUM VOIGHT & MARGARET
OWNER ADDRESS:720 E 72ND AVE
ANCHORAGE, ALASKA 99518-2805
DATE ISSUED: 3/25/93
EXPIRATION DATE: 3/25/94
PARCEL ID:01304344
LEGAL DESCRIPTION: KWIK LOG BLK
3 LT
LOT SIZE: 11135 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE'
DATE
I 0 UTI L tT'F ? rvl~,
N~Ub:iC,~A,.IIY OF %'r'HO'g'AGE
ENVIkGNMr. ,\ft.L ~- F.R'. I,~ 35 ,)IVISlON
.
, ,!.b, 2 $ 199:5
RECEIVED
I hereby certify that I have st~veyed the following
described property: Lo~- 7
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no improvements on prol?
erty lying adjacent thereto encroach on the premises In
.question and that there are no roadways, transmission
hnes or other visible easements on said property except
as indicated hereon.
Dated at Anchorage, Alaska
this__~ 5 day of (~c_-rc~ ~-~ ~ 19 ~'&
H~,,WITT V. LOUNSBURY & ASSOCIATES
Engineers and Surveyors
Page 1 of
EASEMENT
This agreement, made and entered into this ~7.~)day of
of Anchorage, Alaska, party of the first pa~ which expression shall
include his, her, or the iD heirs, executors, ad~nistra~o~s, agents~
o~ as~i~m where the context so requires or admits, and ~.
~b~ ~ ~ ~- ~ )~ of Anchorage, Alaska, party of the
second part, which exp~ssion includes his, he~ oz~ rheim heirs,
executors, administrators, oD age,ts where the dontext so requires
oP admits, witnesseth:
Whereas, the pamty of the first part o~s and has title To that
real estate and ~eal property located near Anchorage, Alaska,
And whe~eas~ the party of the second pa~ owns and has title to
a parcel of p~pe~ty whiah adjoins the fo~oin~ ~d described as
desi~s to g~ant a per~tual ea~em~n~ fo~ the pu~ose of
located at (..{ ~
and the easement shall be within the radius of
from the well site.
Now, therefore, it is hereby agreed as follows:
The party of the second part does hereby grant, assign, and
set over to the party of the first part a perpetual easement for
It is expressly understood and agreed that this easement is a
covenant Punning with the land.
IN WITNESS WHEREOF, the parties hereto have caused this
agPeement to be executed undeP seal as of the day and yeaP fiPst
above written.
STATE OF ALASKA )
THIRD JUDICIAL DISTRICT )
This is to certify that on the (~) day of ( ~
befoPe me, the undePsigned NotaPy Public in and fop tjfe StYe ~f
Alaska, duly commissioned and swomn~ pePsonally appeaPed (
) known to me and to me known to
be the individuals named in and who executed the foPegoing instPument,
and acknowledged to me~ each fop himself and not fop the otheP,
that they signed and sealed the same as theiP voluntary act and deed
fop the uses and puPposes thePein set foPth.
IN WITNESS WHEREOF~ I have hePeto set my hand and official seal
the day and yeam fiPst above written.