Water Well Log - Alaska Department Of Natural Resources
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1STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
WATER WELL LOG
Revised 03/04/2016
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
B
Drilling method:
Air rotary,
Cable tool,
Other ___________
OREHOLE DATA: (from ground surface)
Suggest T.M. Hanna’s hydrogeologic classification system*
Well use:
Public supply,
Domestic,
Reinjection,
Hydrofracking
Fluids used:
Depth
Other
From
To
Depth of hole: __________ ft,
Casing stickup: ___________ft
Casing type:___________
Wall 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: _________,
Assembly From: ________ ft, To_________ ft
Slot size ____________
From: __
____ ft,
To _________ ft
Slot size ____________
From: _________ ft,
To _________ ft
Perforation description ___________ From: ________ ft, To ________ ft
From: ________ ft, To ________ ft
From: ________ ft, To ________ ft
Gravel packed
Yes
No
From ______ ft , To ______ ft
Static water (from top of casing): ________ ft
on ____/____/______
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: _______________
Include description or sketch of well location (include road
Pump size _____________ hp Brand name __________________
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: ..................................................................................
North
Company name:....................................................................................
Mailing address: ....................................................................................
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
City: __________________________ State: AK Zip ___________
copy of the well log be submitted to the Department of
Phone number : (________) ________- ______
Natural Resources within 45 days of well completion.
Please report well logs on the state well log reporting system
Driller’s signature:
available online at:
Date: ______/______/_________
welts-intro-template
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.
OR email electronic well logs to
City Permit Number: _____________________________
dnr.water.reports@alaska.gov
Date of Issue:
_____/____/_________
* Guide for Using the Hydrogeologic Classification System for Logging
Parcel Identification Number: ______-_______-________
Water Well Boreholes by Thomas M. Hanna NGWA Press
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