HomeMy WebLinkAboutNORTON PARK #3 BLK 1 LT 9ANorton Park
#3
Block 1
Lot 9A
#016-211-96
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:SW920047
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:KLATT PAUL H
OWNER ADDRESS:321 E 123RD AV
ANCHORAGE AK 99515
DATE ISSUED: 3/27/92
EXPIRATION DATE: 3/27/93
PARCEL ID:01621196
LEGAL DESCRIPTION: NORTON PARK #3 BLK 1 LT 9A
LOT SIZE: 9946 (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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
LOT 8
UTILITY ~ttSE~ENT$
LOT q
LOT 8 //
EXISTING WEL~/,~o
5CAL. E1%
_~N OF WELL
STATE OF ALASKA
DEPARTMENT OF NATURAL. RESOURCES
DIVISION OF WATER
WATER WELL RECORD
SECTION QTRS
SECTION I TOWNSHIP I RANGE
f-IN []E
[]s E3w
MERIDIAN
LOCATION/SKETCH:
DEPTHS MEASURED FROM:[]--]casing top []-]ground surface
BOREHOLE DATA:
Material Type and Color
Depth
From To
WELL OWNER:
WELL DEPTH:
Depth of hole: ~/'
Depth of casing:
DATE OF COMPLETION
ft
DEPTH TO STATIC WATER LEVEL:
'~ /~ ft below [~ top of casing
Date:
[] ground surface
METHOD OF DRILLING: /~ air rotary [] cable tool
[] other
USE OF WELL: '~ domestic [] irrigation [] monitor
[] public supply [] other.
CASING STICK-UP_- ~ ft. Diam: (',~ in. to~'/' ft
Casing type: ~,,~<.~/~7 in. to ft
WELL INTAKE OPENING TYPE:/~open end
[] perforated [] open hole
Depths of openings: to ft
E) screened
SCREEN TYP...~ Diam: in.
Slot/Mesh Size: --" Length: ft
GRAVEL P~CK TYPE:
Volume usettL
Depth to top:
GROUT TYPF~ Volume:
Depth: from % ftto ft
DEVELOPMENT METHOD:
Duration:
PUMPING LEVEL AND YIELD:
~7 ¢,. ft after ~/' hrs pumping ~/~.~'"'"-_gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETION7 [] YES ~--~-O-
CONTRACTOR INFORMATION:
Regist~ted Business Na~e x' ~
Signature of Authorized Rbspres~:t~tive - Date
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF WATER
PO BOX 772116
EAGLE RIVER AK 99577-2116
Mayor
Development Services Department
Building Safety Division
On -Site Water h Wastewater Program ,•'ifµ
4700 Elmore Street
P.O. Box 196650`LJLJW
Anchorage, AK 99519-6650
www muni oro/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW_
Date of Issue:
Parcel Identification Number: Replacement Only: YES NO
11 Legal Description 11 Property Owner Name & Address: 11
Lot 9A, Norton Park Subdivision 43
p Installation Date: 11-13-2003
Pump Intake Depth Below Top of Well Casing: 70 feet
Pump Manufacturer's Name: Myers
Pump Model: 2NFL52-12
Pump Size 1/2 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: N/A
Pitless Adapter Installer: N/A
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Recirc
Comments:
Paul Klatt
331 (Vest 123rd
Anchoraize,AK
Pump Installer Name: Aaroiv Pump & Well Service LLC
PO Box 110496
Anchorage AK 99516
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.