HomeMy WebLinkAboutT12N R3W SEC 33 Lt 141A & 141B S-8094
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASE REVIEW WORKSrlEET
CASE NUMBER:
"~UBDIVISION OR PROJECT TITLE:
DATE RECEIVED:
COMMENTS DUE BY:
) PUBLIC WATER AVAILABLE ( } PUBLIC SEWER AVAILABLE
) COMMUNITY WATER AVAILABLE
· ' / / / '2/% ' ~ / ....
SOIL LOG
PERCOLATION TEST
11 WAS GROUND WATER
ENGOUNTERED°
12
IF YES. AT WHAT
DEPTH?
POHC~
E
I
ExISTI~
POWER LINE
isNO. $ i/2"
BENT
AL CA P
~10 ELECTRICAL.
TEL ECO~,~UN I CATIONB ESM~T.
Date:
WATERWELL - TEST PUMP REPORT
Ownor ~ ~T~__~.~ - C~' Address
Well Location
Well Information:
Pump Information:
Pump On:
TtL Depth ~Depth of Casing L~r~{~'~) Screen From ~t~-~lTo
Casing Size. ~Screen Dlam ~Screen S~ot
Static Water Level ~O ~ ~ ~ls~t{arge ,'~ _GPM, Max. Drawdown
Time /~/~ ~D,te ~'~ S Pump Off:,~:~/_Time_ .Date
WATER PIBZO- FLOW REMARKS
WATER ~IEZO- FLOW REMARKS TIME LEVEL TUBE GPM
TIME LEVEL TUBE GPM
~/ /~.~/ q' _ __
PORCUPINE
t
POWER LINE,
FND. $ I/2~ B.C.
BEAlY OVERi SET
AL CA P MON,
Moo/for Tube
(54~ 6/5)
49~ 665
14lA
Monitor Tube
$' BL~
7ESE
,~ 5 4~ .150)
40~500
1418
' L
.10 £LECTRICA ~
YE L ECOMMUN /CATIONS ESM~T.
~ TRA/L
/. "? f
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