HomeMy WebLinkAboutMACKNELS TR A LT 3Onsite File
9
Municipality of Anchorage
Community Bevelopment Department
On-Site Water and Wastewater Program
4700 Elmore St. · 16,O. Box 196650 Anchorage, AK 99519-6650 · http://www,muni.0rg/onsite · (907) 343-7904
Well Decommissioning
Legal Address:
On-site Water & Wastewater Program certified contractor performing the well decommissioning:
Well decommissioning date
Method ofdecommissioning: AMC 15.55.060L1 a. [] b. [] c.~,,
Location: Use the space below to provide a drawing of the properly showing the following items;
North arrow
Decommissioned well,
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 corners.
G:\Community Development\Development Services\Building Safety,On Site Water and Wastewater~Forms\Client Forms\Well Decommisioning form.doc