HomeMy WebLinkAboutSOUTHGATE TR 1uthgate
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#018-024-50
Municipar~ of Anchorage
Community Development Department
On-Site Water and Waatewater Program
4700 Elmore St. · P.O. Box 196650 Anchorage, AK 99519-6650 · http://www, muni.org/onsite · (907) 343-7904
Legal A~i~,~;
Subdivision
Well Decommissioning Log
Block Lot
T. R Section Lot.
On-site Water & Westewater Program certified contractor pe~orming the well decommissioning:
Comp. any:
Well decommissioning date
Mekhodofdecemmissioning: AMC 15.55.060L1 a. [] b. [] c. []
Location: Use the space below to provide a drawing of the properly showing the following items;
· O{her water wells on the Froperty,
Two separate swing-tie distances for each well shewe on the drawing,
Note: The swing-fie distances shall he meas~rad from either permanent structures or the property corners.
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.~C~mmunt~yDeve~ = \DeveI~pmentSerwces~tIdmgSafoty\~nSit~W~terandWastew~ter~rms~c~ientF~rms\we~Dec~mmisioningf~rm`d~c