HomeMy WebLinkAboutKINGSBERRY BLK 1 LT 5King
berry
Block 1
Lot 5
#014-141-56
Mark Be ich
Mayor
Development Services Deportment
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.orq/onsffe
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Parcel Identification Number: (~jc].
Date of Issue:
Legal Description
Property Owner Name & Address:
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: ~'~ feet
Pump Manufacturer's Name:
Pump Model: ~'~{~
Pump Size ~' hp
Pitless Adapter Burial Depth:
feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? [~es []
Method of Disinfection:
Comments:
No
Pump Installer Name:
ANOIOP. A~E WEtl. & PUMP SERV.
~0 EAST 7~m A~NUE
~ 9ff/-243-0740
AWI~GOM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.