HomeMy WebLinkAboutROSEWOOD PARK ESTATES BLK 1 LT 10
Rosewood Park Estates
Block 1
Lot 10
#014-134-11
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • ��
907-343-7904
On -Site Water and Wastewater Section
Fax: 343-7997
www.muni.org/onsite
Well Decommissioning Lo
Legal Address:
Subdivision ROSEWOOD PARK ESTATES Block 1 Lot 10
T I R Section Lot
On-site Water& Wastewater Section certified contractor performing the well decommissioning:
Name:
TYLER RIDGWAY Signature:
Company:
ANCHORAGE WELL & PUMP SERVICE
Well decommissioning date 05/11/23 Method of decommissioning: AMC 15.55.060L1 a. b. C. ❑�
Location: Use the space below to provide a drawing of the property showing the following items:
• North arrow
Decommissioned well location
Location of other water wells on the property
• Two separate swing -tie distances for each well shown on the drawing
Note: The swing -tie distances shall be measured from either permanent structures or the property corners.
f 4005V
1-
PC
3 AVE
-- - es
G:\Development Services\Building Safety\On Site Water and WastewaterlForms\Client Forms\Well Decommisioning form.doc