HomeMy WebLinkAboutUS SURVEY 3044 LT 37 E99'
M-~/V DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highwa~
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner_
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing. 6~ .Depth of Hole
Static water level 35 ft.
Screen ( ); Perforated (
Describe screen or perforation
Well pumping test at 15 gallons per
of drawdown from static level.
Date of completion ':k~'tob~'r' 11, 19/M~
6i' feet Cased to 60.6 feet
(below) land surface. Finish of well (check one)
).
open end ( ::~ );
(minute) for ! hours with ~
Depth in feet from
ground surface
WELL LOG Noii~',~.. '~-~:~ ~
Give details of formations penetrated, size of material, ~oqg~oJ~]f~a~f~fi~s .... t
__0 TO
-'- TO
___b TO
i9 TO
43 _TO
55 TO
TO
TO
TO
TO_
TO.
.TO-
_ TO_
.TO_
TO_
19
43
55
61
6 Silt~z f ,ravel
¥i~terb_emr~ ~:ravel
Certific2~ NW~, 81~ g~ ~$
3 -- CONTRACTOR
MUN I C I ~)AL I -1-Y OF A~CHORAE~E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE~ AK 99501
64-47~ )
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
84 }~6.J
07 / i2/84
NORMAN 0 DUQUETTE
3276 VASSAR.
ANCHORAGE, AK 99508
WE]L.~._ PER,~ I T
LEGAL DESCRIP: SUBDIVISION: NA
SECTION: 17 TOWNSHIP:
LOT SIZE: -. 5100 (SQ.FT. OR ACRES)
LOT. LOCATION: CROW CREEK ROAD
LO'F: E1/2-57 BLOCK~ NWl/4
10N RANGE: 5E
1. I am Eamiliar with t~e requirements ~or on-site sewers and wel~s ae set
£ortb by the Municipality o£ Anchorage (MOA) and the State o£ Alaskal
2. I will install the system in accordanc:e with all MOA codes and regulations,
and in compliance with the design criteria o[ this permit.
3. I will adhere to all MOA and State oE Alaska requirements ~or the, set back,
distances £rom any existing well~ wastewater disposal system or public
sewerage system on this o~any adjacent or nearby lot..
/i /
~' ,* APPLI~ ':NT FILLS OUT UPPER HA
Address Zip Code
Phone
Phone
Realty CO. & A~nt /~,~d
Address Zip Code
/.
Ty e of Resi~nce
~ Multiple Family No. of Bedroo~s
Water Supply
~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal ~ ( ~ ~
Public HHlitg Whon ConnectoO to ~uBlio HSlity: I r'~ !~ ~ ~' ~ 0 ? ~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date ~.~.~, ' ,~
Inspector Inspector Inspector Inspector
Field Notes:
(~}~APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
(~--) DISAPPROVED
( ) CONDITIONAL APPROVAL* ~.,