HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 3 LT 15A , WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES '
Division of Geological 13 Geophysical Surveys
L)-/~ /'),,., I1,-;,s
Add,...: ~.~/
Form OE'WWR (U/BI)
Bottom
'?.'USE: .~ Domeetl¢ I--~ Pub.* Supply ri Induetry
~-] Irrlgdtlon 0 Re~hargl I--I Commetleel
I--] T.t wen [] Ot~er:
8. CASING~ I'-I Thceeded ,J~ Welded
FINISH OF WELL:
Type: t~/,,Et,~l' /~;~
fl.
c/,~ .'c'o ? ,
I4,REMARK$:
lB. WATER WELL CONTRACTOR'S CERTIFICATION:
II. PUMPINS LEVEL below lend lurfece end YIELD
~'C') ft. after hrs. pumplfle /0 S.p.m,
__ft, after __hrL pumpinG
IS. PUMP: (if ovelloble) HP
Length of Drop Pipe fl, Oopoclly p p.m.
I-I s.b.,. 0 d., 0 c,.,,,,,:., I-I O,h.,
IO, S?ATSD WATER L~VEL'
I'--IAbove or ~eelow Iofld
PERMIT NO.
~.lLl~ I i_.~ I, RL I Tk' OF R~-ICHdRRGE
DEPRRTMENT OF HERLTH R~'ID ENYIRONMBITRL PROTECTION
825 ~L~ STREET, RNCHORRGE, ~K. ~501
2~4-4720
14EL'L PERP1 I T
< 82e1~ >
RPPLICR~iT
LOCRTION
LEGRL
C&E ENT. INC
L15R B~ CRMPBELL HTS
PO BOX
LOT SIZE
87~ SQURRE FEET
MI~'~IMUM DISTRf'ICE BETI.IEEN 8 I,~ELL RND F~NY ON-SITE SEI4RGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE ~IELL OR 2.50 TO 200 FEET FROM R PUBLIC I,IELL DEPENDING
UPON THE TYPE OF PUBLIC I.IELL
MINIMUM DISTRNCE FROM R PRIVRTE I,ELL TO R PRIVRTE SEI4ER LINE IS 25 FEET RND
TO R COMMUNITY SB,~ER LINE IS 75 FEET.
I,ELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT 14ITHIN ~0 DRYS
OF THE ~,ELL COMPLETION.
OTHER REQUIREMB'~TS MRY RPPLY. SF'ECIFICRTIO['IS R~'~D COf'ISTRUCTION DIRGRRMS RRE
RVF~ILRBLE TO INSURE PROPER INSTRLLRTION.
PERI"1 I T EXP I RES DECEMBER --'--~:-'-I ~::1_~82
I CERTIFY THRT
l: I R[~ FRMILIRR bllTH THE REQUIREMENTS FOR ON-SITE SE~ERS R~D 14ELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I ~IILL INSTRLL THE SYSTEM IN RCCORDRNCE ~;ITN THE CODES.
S I GMED:
RPPLICBf'~T C&E ENT. I~'~C
V4. 0
V4. 0
APPLIC ~IT:FILLS OUT uPPER'HA['-~ONLY
Buyer
Address Zip Code
Address Zip Code
Type of Residence
[:] Multiple Family No. of Bedrooms
[~ Other
~Je.~ AT~ACH V~LL LOG. A v,,I ~og is ;~u~red for a, we,s dd~ed since June ~g75.
I-I Community For wells ~llled prior to that date. give well depth (attach log If available).
r-i Public Utility
I-I Individual Year Individual Inatatled:
When Connected to Public Utility: ~-~
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE.JEST BEFORE PROCESSING CAN BE INITIATED.
Tiros Time Time Tims '
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: jk ~UNICIPALITY OF ANCHORAGE
~',"~'T C'~ "'~
ENVI~. ,,~..I,,A. ! .O ~. :*:.,I
5 E P '~ $ Igs2
RECEIVED
(~.-) APPROVED BEDROOMS 'CONDiTiONS OF APPROVAL
( ) DISAPPROVED
( ) CONmT~NAL APPROVAL'
BY:
Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received
Well to Tank Septic Ta~k Size