HomeMy WebLinkAboutT12N R3W SEC 9 LT 82 S2Development Services Department
Building Safety Division
' On -Site Water & Wastewater Program ^GE BG'`
''t"'✓ 4700 Elmore RoadU
P.O. Box 196650 z: Z
a
Mark Begich Anchorage, AK 99507 s AE T Y
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: 01 2411- 0%
Legal Description
T12M 931-) Sec 9 L 8ai so
Pump Installation Date:
$z�13
Pump Intake Depth Below Top of Well Casing:/ 0:7- feet
Pump Manufacturer's Name: /J,,, d crck �.r
Pump Model: C%VC�tZ_ "
Pump Size � hp
re,
Pitless Adapter Burial Depth: * feet
Property Owner Name & Address:
10
Pitless Adapter Manufacturer's Name: Pe�' d Us _, _
Pidess Adapter Installer:
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection:
Comments: A Ar4s
Pump Installer Name: ANCHORAGE WELL & PUMP SERV.
330 EAST 76TH AVENUE
vlv„ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.