HomeMy WebLinkAboutLAKE OTIS HEIGHTS BLK 1 LT 4MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot 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? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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It is the responsibility of the owner to determine the existence of.\ U .�� �Ff"5
any easements, covenants or restrictions which do not appear on
the recorded subdivision plat. Under no circumstances should EASEMENTS OF RECORD, OTHER THAN
any data hereon be used for construction or for establishing THOSE SHOWN ON THE RECORDED PLAT,
boundary or fence lines. The surveyor takes responsibility for the ARE NOT SHOWN HEREON.
initial transaction only.
LOT BLOCK / LEGEND
® BRASS CAP MONUMENT
X IME d ►'r/ S /f Q G/ -17`x' (PLAT NO.: �D� o ) O`IRON PIPE
ANCHORAGE RECORDING DISTRICT • REBAR CORNER FOUND
o HUB AND TACK
DOWLING & ASSOCIATES
P.O. BOX 110029
ANCHORAGE, AK 99511-0029
(907) 348-0551 OR 348-0665 FAX: 348-0881 REVISION DATE BY
DATE: BY.C_ :gyp SCALE: WORK ORDER: DIARY RID NO.:
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