HomeMy WebLinkAboutCLEARY LT 1i5N
cw��
taw% NEyy
y
Lot
PERMIT NO.
[~EPARTMENT nF HEALTH AND ENVIRONMENTAL PROTECTION
825 ~ STREET, ANCHORAGE.,
279-251:J.
( 7708D )
688-25i6
AF'PLICIZlNT E:,A.LLON_.OBERG P 0 BI..I.,,. ;~7¢i I_:HU..iIHK
LOCA'I" I ON 08ER,O RD, ,
LEGAL W::L,'21NW'I,'~NE:I.../~NEit.,"4~sglril-.-,f'~Ri'LW LQT SIZE 54450 SQ..ARE FEET
MINIMUM DISTANCE BETWEEN A WELl_ AND
:1.00 FEET FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE RED. UIRED AND MUST BE R. ETURNED TO THE DEPARTMENT WI]"HIN ".~0 DR"r'S
OF ]'HE WEL. L CQMPLE'T'ION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE A',/FIILABI_E TO INSURE PR[]PER
I NS'T'AI_LA'[ I ON.
F-"' E;R I'"1 I 3F "¢RLI D F,]mR IZ)I'-.IEE ".r" b'] FIF-: F'F~:,]:,I"'J ][
I CERTIF'¥ THAT
±: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH 8~¢ THE MUNICIP8LIT9 OF ANCHORAGE.
2: I WILL INSTALL THE S'¢STEM IN ACCORDRNCE WITH THE CODES.
RECE VEO
(gertifiei Drilling
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND ~/~],LLoe',d Q~/-,ef.~ DEPTH OF WELL
ADDRESS -~Z c~ STATIC LEVEL OF WATER FT.
LEGALDESCRiPTION_C_~,~ ~ c~r'ol~z~I:- /~2d~'~. t~tfdq_~'~t3 DRAW DOWN FT.
DATE-Started---- $//~a/7 7 Ended ~/~ $-/77 GALS. PER HR
PERMIT NUMBER __ ~l 70~ci KIND OF CASING ~ d~ ~ Or9'
KIND OF FORMATION:
From ~) Ft. to ~ Ft.
From_ ~ ~d Ft. to Ft.
From q ~i' Ft. to /ff'~F Ft.
From /';~!' Ft. to / ~-t Ft.
From ;'~5" Ft. to
From [cID Ft. to
From Z'(~zj Ft. to ~)r;
From __.Ft. to Ft.
From__.Ft. to Ft.
From__.Ft. to.__Ft.
From__Ft. to Ft,
From__.Ft. to Ft.
From__.Ft. to Ft.
From__.Ft. to__ _Ft.
From Ft. to Ft.
From Ft. to Ft.
From__Ft. to FI
From _ _~Ft. to
From_ Ft. to
From
From__
From
From_
From
From
From
From
Ft.
Ft.
Ft.
Ft
Ft~
Ft
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
.Ft. to Ft,
Ft. to__Ft,
Ft. to__Ft,
Ft. to.__ Ft
Ft. to__
Ft. to
Ft. to Ft.
Ft .....
Ft.
MISCL. INFORMATION:
DRILLER'S NAME