HomeMy WebLinkAboutCLYDE M DICKSON BLK 8 LT 16Clyde M.
Dickson
Block 8
Lot 16
#007-053-32
Mark Begich
Mayor
Well Drilling Permit Number: SW
Development Services Department
Building Safety Division
On-Site Water & Wastfwoter Program
4700 Elmot*e Road
P.O, Box ~96650
Anchorage, AK ~07
(907) 3~-7e04
PUmp Installation Log
Date of Issue:
Parcel Identification Number:__
Legal Description
Property Owner Name & Addr, ess:
Pump Installation Date:
;:z
Pump Intake Depth Below Top of Well Casing: ~,~ feet
Pump Manufacturer's Name: ~_~
Pump Model: ~' I"~.
Pump Size IC hp
Pitless Adapter Burial Depth: ! 0 feet
Pitless Adapter Manufacturer's Name: ~?t0c~n~o~.
Pitless Adapter Installer: t~ ~OC
Well Disinfecte~ Upon Completion? J~Yes [] No
Method of Disinfection: ~ D~_JJ,.eS~
Comments:
Pump Installer Name:
Attention: The pump installer shall provide a primp installation log to the DSD within 30 days of pump installation.