HomeMy WebLinkAboutT12N R3W SEC 27 LT 45Mark Begich
Mayor
Development Services Deportment
Building Safety Division
On-Site Water & Wastewate~' Program
4700 Etmore Road
P.O. Box [96650
Anchor'ag¢, AK 99507
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
Parcel Identification Number:
ILegal Description
Pump installation Date:
Pump Intake Depth Below Top of Well Casing:
Pump Manufacturer's Name:
Property Owner Name & Address:
Pump Model:
Pump Size ~/~__ hp
Pitless Adapter Burial Depth: I 0 feet
'itless Adapt~r Manufacturer's Name:
'itless Adapter Installer: ~J ~
7Vell Disinfected Upon Completion? ~Yes [] No
Method of Disinfection: ~..~. }a~..t_]_~
Comments:
Pump Installer Name:
,mchora~e Well & Pump Service, h~.
330 East 76th Avenue
Anchorage, AK 995].8
Phone: 907-243-0740
Fax. 9n7.~43-0742
Attention: The pump installer shall provide a pump installati~rn log to the DSD within 30 days of pump installation.