HomeMy WebLinkAboutDOWLING LT 14Jan 11 22 05:59p Anchorage Well & Pump Ser
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MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Pa reel Identification Number: 01" t ;?-
Date of Issue: - -
Legal Description Block Lot Pro
pperty Owner Name &Address:
Pump Installation Date: - -
6
Pump Intake Depth Below Top of Well Casing: feet
Pump Manufacturer's Name: 7� r�l
Pump Model: 5
Pump Size: 1f-2— hp
Pitless Adapter Burial Depth: a )0"o'i_ feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? 91yes ❑ No
Method of Disinfection: ✓��"�
Comments:
Pump Installer Name: _
ANCHORAGE WELL &PUMP SERVICE
Company: 7640 KING STREET
ANCHORAGE, AK 99518
1blailing Address: 907-243-0740
11 City: State: Zip: 11
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.