HomeMy WebLinkAboutT12N R3W SEC 9 E2 Lot 19 Got Subdivided into Moose Ridge S/D
,a-W DRILLING, INCo
DRILLING LOG
Well Owner : I, -~ ....... Use of Well
Location (address of: Township, Range, Section, if known; or distance main road_
t '.'] %,i ~ '~ '".h
Size of casing. (/~ .Depth of Hole_ !-:~ '~ feet Cased to ~,~ ' ~ ii b feet
Static water level__ 'i t. ft. (~Bi~(~) (below) land surface· Finish of well (cheek one)
Screen ( ); Perforated ( ).
Describe screen or perforation ~]
Well pumping test at 2(' gallons per (hour) (minute) for ? hours with
of drawdown from static level.
Date of completion
open end (> )
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
ft.
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2 -- $TA'rE
M-W DRILLING, INC,
Well Owner_
DRILLING LOG
.Use of Well
Location (address of: Township, Range, Section, if known; or distance mmn road
Size of casing. .Depth of Hole
Static water level ft, (above)
Screen ( ); Perforated (
feet Cased to feet
(below) land sur£aee. Finish of well (check one)
).
Describe screen or perforation
Well pumping test at__gallons per (hour)
of drawdown from static level,
Date of completion
open end (
(minute) for
hours with
ft.
WE~.L LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
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' :-~ .TO.
] ' ~ r ~TO.
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2 -- STAT E
7! ] [ ~ 2./l/ I'~ INDIVIDUAL SEWAGE AND WATER FACILI%£ES ~,/, Z .'g~-
'~ ',.~ of pe~san requesting a p~oval
q. Nulabe~ <-j. bed~.ooms in house
5. Wate~ Ana]y. Sls:
a. hactgY.]a]
Distance from well to closest existing or proposedj
4. Cesspool'
5. Property Line~%~'~
6. Other sources of possible contamination
houses, barn~ dmainage ditch, etc. '-~,
Sewage d~sposa], system.
Age of system ,~(
Septic tank capacity in
Uame of septic tank msnui-'actue~ ...... - ......... -~- .'
].. If "home made" show diagram on reverse side of this form,
Disposal field or seepage pit size arid type______ ...........
1, Bistance to property line /-/~{
to house fo~mdation
~, Percolation, Tes~ Y'e~ul~s
f. Percolation Test performed by
[3se the reverse .side of this form to show diagram, Diagram should include
"the fo]lowing Jnformatic, n: p~operty lines~.well location, house location,
~,~!,t~c tank location, disposal area ].ocat[on, location of percolation test,
a~.d direction of [~round slope.
9. The ~,,r.,,~tr--+i{~n on this form is; true and correct 'to the best of my knowledge.
SiF9 al: ute :Z~c--~n ~- ............. Date Si?ned
~__?. ~.E FILLED OIJT BY HEALTH DEPAETI.!ENT PERSONNEL
above described sanitary facilities are hereby approved, su.bj__ect to the
r._o~].:.low~n? cond!~tions:
Conditions
The above described sanitary facilities are disapproved for the following
Date ' , ?, :'~ ~
Approval J s valid for, one yeap following the data of approval.
CPJ: cw
DATE
r 6. RTMENT C)F HI~ALTH AND WEP'
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
OFFICE
NAME
ADDRESS
Records irl this office indicate thls WATER SUPPLY ,lo be
Analysis shows Ibls Woler SAMPLE
Salidaclory [~ Questionable [] UnsollsJactory,
ff on "Unsotislaclory" or "Questionable" stalus is indicated above
you should toke JrnmediMe action as recommended below.
__1. Notify consumors water is poiluJed. Boll or chemically
SAMPLE COLLECTED BY-- om
om
DATE COLLECTED '~ME COLLECTED
When? __
Oi~meler of Well Deplh Feel
Well Casing
__ 2, Increllse chJarinalioo sufficiently Io meet recommended rosJdual standards.
3, Checll ¢blari~aEon and other mecbonlcal equipment. Make certain ii is
funcJianJng properly.
~. ff i~JJe~ ~heck~Pg equipmee~ a dlsinJeding residual is no~ obJoined, please
5. This is c~ surface water source and subjeelJo pollution by man crud animals.
6, Improve your [] spring [] dug well [] drivenwelJ
~] drilled well ~] cistern,
9. Conlactyour nearest [] Local Health Deporimenl or ~] Alaska
5ANITARIAN'S REMARKS
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Laclose Broth 10cc 1Oct 10cc 1Oct J 10cc 1.0cc O.Icc
48 hours
EMB- AGAR.
Lactose 0raSh, 24 hrs. 48 hrs. .(~ram's slain ·
Coliform Density (Mosl probable No, per lOOcc.)
MF resulls ~
Absenl
