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Home My WebLink AboutBIRCH HILLS TERRACE BLK 1 LT 1 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______ City/Borough Subdivision Block Lot Property Owner Name & Address Well location: Latitude Longitude Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna’s hydrogeologic classification system* https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD Depth From To Drilling method:  Air rotary,  Cable tool,  Other Well use:  Public supply,  Domestic,  Reinjection,  Hydrofracking  Commercial,  Observation/Monitoring,  Test/Exploratory,  Cooling,  Irrigation/Agriculture,  Grounding,  Recharge/Aquifer Storage,  Heating,  Geothermal Exploration,  Other Fluids used: Depth of hole: __________ ft Casing stickup: ___________ft Casing type: __________ Casing thickness: _________ inches Casing diameter: _________ inches Casing depth: __________ ft Liner type: _________ Depth: _____ ft Diameter: _____inches Note: Well intake opening type:  Open end,  Open hole, Other Screen type: _________, Screen mesh size: ____________ Screen start: ________ ft, Screen stop:________ ft, Perforated  Yes  No Perforation description: Perf from: ________ ft, Perf to: _______ft, Perf from: ________ ft, Perf to: ________ ft Gravel packed  Yes  No Gravel start: ______ ft , Gravel stop:______ ft Note: Static water (from top of casing): _______ ft on____/____/_____ Artesian well  Pumping level & yield: ______ feet after _____ hours at _____ gpm Method of testing:__________________________________________ Development method:______________ Duration: ____________ Recovery rate: _________ gpm Grout type: _________________ Volume __________________ Depth: From ___________________ft, To ___________________ft Final pump intake depth: __________ ft Model: _______________ Pump size: _____________ hp Brand name: __________________ Include description or sketch of well location (include road names, buildings, etc.): Was well disinfected upon completion?  Yes  No Method of disinfection: Was water quality tested?  Yes  No Water quality parameters tested: Well driller name: .................................................................................. Company name: ................................................................................... Mailing address: .................................................................................... City: __________________________ State: AK Zip: ___________ Phone number: (________) ________- ______ Driller’s signature: Date: ______/______/_________ Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: _____________________________ Date of Issue: _____/____/_________ Parcel Identification Number: ______-_______-________ *Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https://dnr.alaska.gov/welts/ OR email electronic well logs to dnr.water.reports@alaska.gov North 014N n STEVE KISSEE , NE 907 3287 B1 SW Municipality of Anchorage ANCHORAGE NE WAYNE WESTBERG 1973 S n n SW002W 945 PO BOX 110378 10 4960 M-W DRILLING 602 11 n BIRCH HILLS TERRACE 12 99511 n 6R[!)~"~ ANCHORA6E AREA BOR"~"~H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATmON~"~/,~O ~'~ /-/~-~ ~'~Z~Y ~, LEGAL DESCRIPTION ~! '~ SEPTIC TANK: ~ {oC'"X ~',¥ ~" D,STANCE _~e/tC NUMBER OF FROM WELL - MANUFACTURER MATER,AL CZ~Z. COMPARTMENTS INSIDE WIDTH LIQUID DEPTH INSIDE LENGTH IIQUID CAPACITY J~? GALLONS. SEEPAGE PIT.' .UMBER OF P,TS / D,AM~ER ~' OR W.OT. J' LE.GT./J-~ DEPT. LINING MATERIAL (~/D/Zf'~" ~L~_( 4.- ~ I,,.~.~. I CRIB 51ZE; DIAMETER_~DEPTH "~ ! DISTANCE FROM.' WELL f, TOTAL EFFECTIVE BUILDING FOUNDATION '~ NEAREST LOT LINE ~' ABSORPTION AREA (WALL AREA) ~- ADDITIONAL ABSORPTION TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE TANK __ SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-O31 DIAGRAM OF SYSTEM L (~I'.A.A.B. GrEATer ANCHOrAgE ArEa BOrOUgh SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT PERMIT NO. INSTALLATION OF: SEPTIC TANK I ~ ~ SEEPAGE PIT DRAIN FIELD TO BE INSTALLED BY FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION I~Y THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SiZE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEEPAG'E PIT ~ I SEPTIC TANK ~, * SEEPAGE PIT · ~ DRAIN FIELD SEEPAGE PIT laOr DRAIN FIELD TYPE DIAGRAH OF SYSTEM Performed For Leaal This /]/)/'.f J'~/~ /~/~'~" Date Performed Description: Lot / Block // Subdivision ~/~-~/~ ~//~ Korm Reports Soils Lo~ neoth Feet 7~ Pefco1 at1 on. Test Soil Characteristics Was Ground Water Encountered? Yes, At what Depth? Readin.q , Date Gross Time Net Time I Depth to 1~20 Net Drop' I Percolation Rate Proposed Deoth of CAq~ENTS: Test Performed Minute Insta)lation: Seenaoe Pit Drain Field Inlet Depth To Bottom Of Pit Or_ Trench Property ~wner Buyer . .. - Address ~ending Instl~tion APPLI'"ANT FILLS OUT UPPER HI`.-`=- ONLY Zip Code Address Realty Co. & Agent Legal Oescrlpt ~n Street Type of Residence %SM[ n g I · Family ultlple Family I-I Other Water Supply ~.lndivldual ~'o// ,~/.~_.,~ / .ii NO. of Bedrooms ~' Zip Code Phone Zip Code ATTACH WELL LOG, A well log Is required for all wells drlled alnce June 1975: For wells d~llled prior to that date, give well depth (attach log II available). Year Individual Installed: / ~.~'.T~_~ When Connected to Public UtllJty: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE(~JEST BEFORE I~ROCESSING CAN BE INITIATED. Inspector Inspector Inspector Inspector Field Notes: ( · ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: ~o115 Rating I Date Sewer InstaIleq I Well To Absorption Area Well Log Received I Well to Tank Beptlc Teck Size