HomeMy WebLinkAboutLot 07C �
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;Mark Begichegich
Mayor
iEvefcprrIerct Services CDepari'rent
rcuilding Safety et`f D ivisiori
Or'i-S e \ry eter C :1r4l as t z'i!uiar Program
4700 Bragaw 5trset
P.C. Sax 196650
,ncicrege,
.AK 99519-6650
k•+ww.muni.arminnsite
(907 343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
parcel Identification Number:
Legal Description
CAJSTL/ELc)
V j L G, !� i5 2
Pra o erty Owner Name & Address:
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Pump Installation Date: iU/,z> J/ C,
Pump Intake Depth Below Top of Well Casing: 5 ' feet
Pump Manufacturer's Name:
Pump Model: COi.S /
Pump Size /� hp
pitless Adapter Burial Depth: l feet
Pitless Adapter Manufacturer's Name:
p-itiess .adapter Installer:
7;v/ell Disinfected Upon Completion?
!Method of Disinfect on:
Camments:
--, c
,; es ';-1 No.
Pump Installer Tame:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation-