HomeMy WebLinkAboutBURLWOOD TERRACE #1 Block 21 Lots 1A, 2A, 3A, 4A & 5ABurlwood
Terrace #1
Block 21
Lot
1A,2A3A4A,
5A
Municipality of Anchorage
Community Development Department
On-Site Water and Wastewater Program
4700 Elmore St. · P.O. Box 196650 Anchorage, AK 99519-6650 · http:llwww, muni.orglonsite · (907) 343-7904
Well Decommissioning
Legal Address:
Subdivision ~l~-r(~oOc~ ~'~r~'~r--~lBIock ~J Lot /
R Section Lot
On-site Water & Wastewater Program ~ertified contractor performing the well decomm~
Company: /
Well decommissioning date
Methodofdecommissioning: AMC 15.55.060L1 a. [] b. [] c. [~
Location: Use the space below to provide a drawing of the property showing the following items;
North arrow
· Decommissioned welt,
· Other water wells on the property,
Two separate swing-tie distances for each well shown on the drawing,
Note: The swing-tie distances shall be measured from either permanent structures or the property comers.
-kk e
: 'ty p p ' ' ' g ty ' ~ter ~ ' t Forms\Well Decommisioning form.doc