HomeMy WebLinkAboutEASTRIDGE #3 BLK 1 LT 12Eastridge
Block
Lot 12
#003-264-43
0
Mark Beg/ch
Mayor
· Developmen¢ 5¢rvices Dcpc~('tment
On-Si're Water & Waste~ter Program
P.O. Box ~95650
Anchoca98, AK 99519-6650
(907) 343L7904
Well Drilling Permit Number: SW
Pump Installation Log
Date of Issue:
Parcel Identification Number:
Legal Description Property Owner Name & Address:
Pump Installation Da~e:/~/t3/~ ~ 3
Pump Intake Depth Below Top of Welt Casing: feet
Pump Manufacturer's Name:
Pump Model: ~:~O~_~l -- ~V~-<~I.9~-
Pump Size V2-- hp
Pitless Adapter Burial Depth: feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion?~Yes [] No
Method of Disinfection: p~/~ _
Comments:
Pump Installer Name:
Anchorage Pump & Well Service
330 East 76th Avenue
Anchorage, Alaska 99518
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.