HomeMy WebLinkAboutROGERS PARK BLK 8 LT 6Municipality of Anchorage
Community Development Department
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
Well Decommissioning Log
Legal Address: �
Subdivision �9�°�'�`' ear U- ��+ Block e) Lot
003-1 �3 -37
T R Section Lot
On-site Water & Wastewater Program certified contractor performing the well decommissioning:
Name: � G
V '}iE ��� enc' Signature:
—� P0. B0112130
Company: � 94 gy,99511
Well decommissioning date I6 19 Method of decommissioning: AMC 1 .55.O6OL1 a. ❑ b. ❑ C. a,
Location: Use the space below to provide a drawing of the property 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 comers.
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