HomeMy WebLinkAboutWOODLAND PARK LT 16CR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE
1 OF
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW960323
DESIGN ENGINEER:
OWNER NAME:EVANS WILLIAM OSMOND SMITH
OWNER ADDRESS:3411 WILLOW PL
ANCHORAGE, AK. 99517
DATE ISSUED:10/.~'/96
EXPIRATION DATE:10/~/97
PARCEL ID:01009426
LEGAL DESCRIPTION:
WOODLAND PARK LT 16CR
LOT SIZE: 8223 (SQ. FT.)
NUMBER OF BEDROOMS: 1 THIS PERMIT: 1
THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENSURE 100 FT. SEPARATION BETWEEN WELL AND ANY SOURCE
OF CONTAMINATION. WELL CONSTRUCTION MUST BE IN
ACCORDANCE WITH THE NEW REVISED WELL ORDINANCE
(AMENDED AND APPROVED 08/13/9~)--AMC15 55, WATER WELLS.
RE CE I VED
ISSUED BY:~
DATE:
DATE:
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362.00
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LOCATION OF WELL
BOROUGH
LOCATION/SKETCH:
DEPTHS MEASURED FROM:~.casing top ~]ground surface
60REHOLE DATA:
Material Type and Color
Depth
From To
SECTION QTRS
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
WELL OWNER:
WELL DEPTH: ;DATE OF COMPLETION
Depth of hole: //~/'O ft
Depth of casing: ,¢~,~ ft
DEPTH TO STATIC WAT~ER LEVEL:
'~ ft below '~-top of casing
[] ground surface
Date: ~'~::~ / / ~ ! ~
METHOD OF DRILLING: ~L~ir rotary [] cable tool
[] other
USE OF WELL: ~domestic [] irrigation [] monitor
[] public supply [] other
CASING STICK,~U.~__P: ~:~ ft. Diam: ~ _in, tO~
Casing type: ~--~-- ~ in. to
WELL INTAKE OPENING TYPE: '~open end [] screened
[] perforated [] open hole
Depths of openings:
to ft
SCREEN TYPE: Diam: in.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
VoJume used:
Depth to top:
GROUT TYPE: Volume:
Depth: from ft to ft
DEVELOPMENT METHOD:.,
Duration: ~-.'> ~
PUMPING LEVEL AND YIELD:
./'.~ ft after
~ hrs pum ng ,' gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETION? D.YES [] NO
CONTRACTOR INFORMATION:
'~gi~ered Busines~ Na~- ' ~:' '
~gnature of Amhonzed Respresentative Date
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF MINING & WATER MGMT
3601 C St, Suite 800
ANCHORAGE AK 99503-5935
Phone (907)269-8639, Fax (907)562-1384
7.00*_
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