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T15N R1W SEC 16 S2SE4NW4 PTN & NE4NE4SW4 PTN
www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address T15N R1W Sec 16 S2SE4NW4 PTN & NE4NE4SW4 PTN 18915 OLD GLENN HWY JOYCE O’CONNOR Pump Installation Date: 3-14-19 Pump Intake Depth Below Top of Well Casing: 56 feet Pump manufacturer’s Name: F&W Pump Model: 4F07P05305S Pump Size: 1/2 hp Pitless Adapter Burial Depth: N/A feet Pitless Adapter Installer: N/A Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: N/A Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.