HomeMy WebLinkAboutYALE BLK 2 LT 3Sep_21.2022 09:33 AM Anchorage Well & Pump Service Inc 9072430742 #0565 P 1/ 1
Municipality of Anchorage
Community Development Department
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.Muni.org/onsite • (907) 843-7904 r
Well Decommissioning Log CIO-? sqj
Legal Address:
Subdivision A L6 Block 2 Let
T R Section Lot
On-site Water lt, Wastewater Program certified contractor performing the well decommissioning:
Name' __7=
IMA. MVA
i Signature;gr__
Well decommissioning date Method of decommissioning: AMC 1,55.Q6DL1, [� h. C,
Locatlow Use the space below -to provld& a drawing -of the proper1"howlpqjh&following Items;
• North arrow
• Decommissioned well,
• Other water wells on the property,
• Two separate awing-tle distances for each well shown on the drawing,
Note: The swing -tie distances shall be measured from either permanent structures or the property corners,
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Development117evelopment ServiceslBul[ding SafetylOn Site Water and
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4231 Emerald Dr,
Anchorage, AK 99502
