HomeMy WebLinkAboutBURLWOOD TERRACE BLK 23 LT 411~I1~
pERMIT NO.
~'1 I_! I'-~ Im-: ][ F' Ft L ][ T '~" Em F F-I i"-~ C: H ,]~ F-: F~ ~_3 E
[:,EF'FtRTMENT HEFtL. TH FIN[:, ENV IF:ONMENTFtL ~:OTEE:T I ON
8:-'"5 "'u-' STREET, FtNCHORFIGE., FtK.
2~4-472F~
L.IELL F'EF-:£'I I T
,:] 8-_-':05ii: )
RRPPLICFINT
LOCFITION
LEGFIL
BUILDING CRFIFTS iNC. 200 H.
L 4 BK 2~ BURLN00P TERRRCE
~4TH SUITE
LOT SIZE
24~-5681
i0000 SQIJRRE FEET
M I N I MUM [:, I STFII'.,IC:E E:ETI.,IEEN FI HELL AN[:, Rl".l"r' ON-S I TE SEI.4FIGE [:' I SPOSRL SYSTEM I
"IE'~O FEET FOR FI F'F.:IVFITE WELL OF.: '150 TO 2F'm:"~ FEET FF-'EM FI PUE:LIC b. IELL DEF'ENE:,ING
UPON THE T"r'F'E OF F'UBLIC P. IELL
MINII'ILtM [,ISTFINCE FF.:Fd"I R F'RIVFITE WELL TO FI PRI'v'FITE SEWER LINE IS c'.'5 FEET FII",tE:,
TO R COMMUNIT"¢ SEI.4ER LINE IS 75 FEET.
14ELL LOGS FIRE REQUIRED FIND MUST BE RETURNED TO THE [:,EF'RRTMENT 1.4ITHIN
OF THE WELL COMPLETION.
OTHEF.'. REQLIIREI"IENTS t'lFi"r' RPPL"r'. SF'ECIFICRTIONS FIND CONSTRUCTION DIFIGRFII"IS FIRE
W',"FIiLFIE',LE TO INSURE PROPER INSTFILLFITION.
F'EF: f-11 'T E :=-:: F' I F-:ES [:,E C E~-IE:E F-: "'~--: t.. t9:=:-:~::
I CERTIFY THRT
i- I AM FRMILIRR WITH THE REij!I_ilREMENTS FOR ON-SITE SEWERS RNE:, WELLS RS SET
FORTH E:9 THE MUNICIPRLITV OF RNC:HORRGE.
2: i WiLL INSTRLL THE SgSTEM IN RCCORDFINE:E HITH THE CODES.
SIGNED:
ISSUED
V4. 0
P~PL I CRN T
LOCR r [ ON
LEGAL
__.
L 4 8K 2~ 8URL~O0 TERRFICE
~4TH 5-U[ rE ~3~
TO R CO~[TY ~R L[~ IS 75 FEEF. "
0~ ~E~JJI~IE~IT~ ~'f ~'f. 'SPECIFICATIONS ~D CO~STRIJCT[ON DI~5 ~E
~V~t~E TO [N~U~ PROPER [NST~LRT[ON
[ C~T[FY THRT
l' [ ~4 FSMIL[8R bi[TH THE REQU[RE~NTS FOR ON-SITE '~S ~ ~LS RS ~T
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ Geophysicol Surveys
Drilling Permit No.
LOCATION OF WELL (Pleale complete either Ia, lb or lc.) A.D.L. No.
Township N [:'1
Range
E[--~
Meridian
DISTANCE
AND
DIRECTION
FROM
ROAD
INTERSECTIONS
Address:
Street Address and Area of Well Location [.i .... '~. .... .
2. WELL LOG Feet Below
Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
Malaria Type Top Bottom
· e diam. in. to ft. Depth Stickup . ft.
' -- ~ ~ ~"-"-- Backfilling Gravel pack
I0. STATIC WATER LEVEL: ft.
... ~ ~bove or ~ Below I~nd surface
ft. ~fter ~rs. pumping g.p.m.
~UNICIPALI~ OF A~,
DEPT. OF HEALT} & Moteri~l: ~ Neat Cement ~ Other:
...... ~M~NTAL ~O 'ECTION I~. Pu~P: (if ~v~Jl~ble) HP
Length ~f Drop Pipe ft. copucity g.p.m.
JUL ! ![
~ SUb'. ~ Jet 0 Cenfrificol O Other
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Wafer Temperature o ~ F ~ C
This well ~os drilled under my jurisdiction end this report is true to the best of my knowledge ~nd belief;
Registered Business Name Contract License Number
Signed: Date;
Authorized Representative
Form O2-WWE (11/81) Copy Distribution; WHITE-State DGGS, PiNK-Driller, CANARY-Customer
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