HomeMy WebLinkAboutWONDER PARK BLK 3 LT 1MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • 907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Well Decommissioning Log
Legal Address:
Subdivision WONAC/6, PAKK Block J Lot
T R Section Lot
On -site Water & Wastewater Section certified contractor performing the well decommissioning:
Name: - „' / Signature:
Well decommissioning date & A Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ c.)V
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 comers.
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G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning fomr.doc