HomeMy WebLinkAboutBLUEBERRY HILL BLK 3 LT 1050 - 202- oq
MUN~I C I PAL I TY OF A.NCHQRA8E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGEs, AK 9~501
264.-4720
ON---SITE WELL PERM, I-[
PERMIT NO:
DATE ISSUED:
840568
07/12/84
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LO]' SIZE:
LOT LOCATION:
MARK/MARGIE NEWMAN
SR 1499B
EAGLE RIVER, A~( 99577
6~4-568~
SUBDIVISION: BLUEBERRY HILL
SECTION: ~ TOWNSHIP: 14N
2.12A (SQ.FT. OR ACRES)
EAGLE RIVER ROAD
LOT: 1 BLOCK: 5.
RANGE:
I certify that:
1. I am familiar with the requirements for on-site sewer, s and ~lls as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regul.mtions~
and in compliance with the design criteria of this permit.
5. I will adhere to all MOA and State o{' Alaska requirements for the-se.~ ba(~k
distances ~rom any existing well~ wa~tewater disposal system or public
sewerage system on this or any adjacent or nearby lot..
APPLICANT: M~K/M~GIE NEWMAN
~ ~~~- DATE= ___7~~
ISSUED BY ~/'
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 8~ Geophysicel Surveys
LOCATION OF WELt. (Please complete either Io, lb or lc.)
IO l I-°'-°'-°'-
~IS~A'NCE AND'DIREC~N F~M ROAD INTERSECTIONS
S
treet Aodreus and Area of Well Locofion
. WELL LOG
M~terlol Type
Feet Below
Sur face'
Top Bottom
Drilling Permit No.
A.D.L. No.
$. OWNER OF WELL:
.,. . Address: 5/~ t4<1'¢1 i~
4. WELL DEPTH: (final) 5. DATE OF COMPLETION
~,,. ,5 -AUra- ~
4.4-
t44-
[] Auger []dotted [] Bored [] Other:
7. USE: [] DomelliC [] Public Supply [] Industry
[] Irrigation [] Recharge [] Commertcal
J~ Test Well [] Other:
........................................
]VINgWNO
=iD AJ.l'tYdl:
~IAN::I
)INflW
WATER WELL CONTRACTOR'S CERTIFICATION:
8. CASING:
diam. (1
liom.
[] Th;Laded [] Welded
... In. to ,..~',:*~ ft. Depth Weight J "'~,* :~. lbs./ft.
in. to ft. Depth Stickup__~ ft.
g. FINISH OF WELL:
Type:
Slot/Mesh Size
Set between
Backfilling
Diameter:
Length;
ft. and
Gravel pock
ft.
I0. STATIC WATER LEVEL: ,. ..) fl. _
[] Above or [] Below land surface
Equipment used:
PUMPING LEVEL below land surface and YIELD
~ft. after J hrs. pumping ,~'=' g.p,m.
ft. after hre, pumping __g.p.m.
12.GROUTING Well Grouted: [] Yes [] No
Materiel: [] Neat Cement [] Other:
~.~ Other
IS. PUMP: (if available) HP
Length of Drop Pipe ft. capacity
[] Subm. [] Jet [] Centrific.l
14. REMARKB:
g.p.m.
15. Water Temperature ,° ~ F [] C
This well was drilled under my jurisdiction and this report is true lathe best of my knowledge and belief;
Registered Business Name Contract License Number
Adthorized Representa ire
Form OZ-WWR (ii/BI) Copy Distribution; WHITE-State DGGS, PiNK-Driller, CANARY-Customer
TO
F
R
O
M
SUBJECT
DATE ,'
/.
REPLY
SIGNED
SIGNED DATE//
SEND PARTS I AND 3 INTACT - POLY PAK (50 SETS~ 4P472
~t~o-~-~'-~]® 4S 472 PART 3 WILL BE RETURNED WITH REPLY.
DETACH AND FILE FOR FOLLOW-UP