HomeMy WebLinkAboutC STREET INDUSTRIAL BLK 1 LT 3T-1 [HP UsT zCL
~ rVI-W DRILLING, Inc.
P. O. Box ,1-1224 o 13]0C Inte, nationa! Airpoll Road
(907) 274-4(~11
ANCltORAGE, ALASKA 99509
DRILLING LOG
RECEIVEb
Well Owner___Ad¢!_f ZerRa11_
Use of Well Dom.
Location (address of: Township, Range, Section, if known; or distance main road
LoC 3T Block 1 C St:. Indust:r£a1- Park, Anchorage
Size of casing 6"
Static water level
Screen (
.Depth of Hole_
37 .ft.
"); Perforated (
Describe screen or perforation Nf~_A
Well pumping test at 10__gallons per (~exa¥)
of drawdown from static level.
52 feet Cased to~-]--z--6-- _feet,
(below) land surface. Finish of well (check one)
).
open end (
(minute) for___~ ...... hours with 100%
Date of completion_ 1_0/13/79
WELL LOG
XX );
Deplh in feet from
,~round surface
Give details of formations penetrated, size of material, color and hardness
.... 0 TO
~ _TO
_
_59_TO
_ 50 TO
_ TO
..... TO
..... TO
...... TO.
....... TO_
...... TO
........ TO_ __
.... TO_
.... TO
2
30
40
50
Casing stickuo
Clay_
GravellE__c_}a_y
Wet sandy~r~x¢l
Sand gravel
DO [)U/n'u '
1 -- CUSTOMER
.~. ~.. DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE % ? DATE
,NSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECt'ON' DEPT.
825 L Street - Anchorage, Alaska 99501 ENVI~OH~E~TAL
ENVI RONMENTAL SANITATION DIVISION ~ ~. ~'~
Telephone 284-4720
DI ~fiCTIOffi~: Complete all parts on pa~e 1. In~ompl~t~ r~qu~ ~ill not b~ pro~d. ~lease allo~ ten {10} da~s for processing.
MAILING ADDRES~
PROPERTY RESIDENT (If ~ifferent from above) J PHONE
2. BUYER PHONE
MAILING ADDREss ~ ~ - -
3. LENDING INSTITUTION - ~ ~ PHONE
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four Other
[] Two [] Five
[] Three [] Six
7. WATER SUPPLY
· ~ INDIVIDUAL*
F-'I COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev, 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE
[] TWO
NUMBER OFBEDROOMS
[] THREE [] FIVE
[] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTI LITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
Septic/Holding Tank
Absorption Area lSewer Line
INearest Lot Line
DATE
~'~PPROVED FOR ~~BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
/
72-010 (Rev. 6/79)