HomeMy WebLinkAboutT16N R1E SEC 29 N2NE4 „cvA`iTv MUNICIPALITY OF ANCHORAGE Y,nenr
• \ On-Site Water &Wastewater Program �Q. `)e
r PO Box 196650 4700 Elmore Road
Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
httpa/www.muni.org/onsite > '
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Department
NCHORoE.
On-Site Water System Permit
Permit Number: OSP191260 Effective Date: 7/2/2019
Work Type: Well Initial Expiration Date: 7/1/2020
Tax Code Number: 05228101000
Site Legal Address: T16N RIE SEC 29 N2NE4 G:1903
Site Mailing Address: 31401 EKLUTNA LAKE RD Chugiak
Owner: DOWNING ERLINDA D Lot Size in Sq Ft: 3484800
Design Engineer: Total Bedrooms: 2
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 2 Private Well 0 Water Storage
All construction shall 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 (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
To close out this permit, please submit the following:
1) Well log
2) Pump install log
3) Water sample results for total coliform, nitrates and arsenic
4) Decommissioning log for existing well that was damaged in the earthquake
Adif
7/C-
Received By: � Date:
'7119
Issued By: }�,� Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department �4 Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. C52 .-; g/-0)
Property owner(s) 1Ll,''04 ,i9 1--- /Day phone dike— C,Mailing address 46g2C '77 � e , L ,In w_-o_ J 9-Site address 31601 E k P 4 / c/ , 48,fei.E 9 Z ..
Legal description (Sub'd., Block & Lot) 7L Al g IF (St 629 V a A/E y
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms o�
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial V Single Family (SF)
(w/wo ADU)
Septic Tank ❑ Upgrade ❑ Duplex (p) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well LY
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Co.- .
ignature of property owner or au orize. 1.ent)
Permit/Rush Fees: A 07,2 Waiver Fees:
Date of Payment: 6/a 6 1 9 Date of Payment:
Receipt Number: Q g ci 3 3 G Receipt Number:
Permit No. OSP 19 1 a ( O Waiver No.
G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Pemiit Application.doc
__ __ WELL SITE PLAN ERLINDA DOWNING
31401 EKLUTNA LAKE RD.
CHUGIAK, AK. 99567
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1. 116 N R 1E SEC 29N 2NE4 (052-281-01-00019)
2. SEE DRAWING ABOVE
3. SEE ATTACHED
4. SEE DRAWING ABOVE
5. N/A PROPOSED WELL SITE MORE THAN 150 FT. FROM EXISTING WELL
6. SEE DRAWING ABOVE
7. N/A
Sco..te : 1 " 30 I
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
PO BOX 110378
SE
WAYNE WESTBERG
E DOWNING ,
M-W DRILLING INC
001E NE
907
NENE29
n
23975
345 4000
Eklutna
Anchorage 99511
S 016N