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HomeMy WebLinkAboutMEADOW ROAD LT 1-S-3-, 10 20 04:r -2r- Anoho:age. WGN &Pump Set ;.C,7243074? p 7 L 'Vark SegiCl-, Mayor Pump Installation Log Well Drilling Nxinit Number: SW__. Date (if Issue. Parcel Identificatiou Nuvjibe,; Legal Description. I ropeeVy Owner Name '4diress: Me -4 0,- C1 Pump Installaiion Date - Pump bitake Depth Below'fop of NVell Casing: feet F*ufnp N1.1fluloctuit-er-'s. Niwe: /Id IT PUX151) Model: ii runio Size P Pitless Ad3riter But in) Depth- feet PitlessAdapter Mmie. f Pitless Adapter IwAaller-: NAW Oismfect:Ld Upon Compktion? wf Y.S El Nu Nlethp-d of Disinfectlow. comments: Pates Pump Installer Name. :,"olchorage dell & pmr;p 'S' ;; -, ." . .330 East 76th Avenge Anchor3ge, AK 99",'18 Rive: 907-243-0740 Fa4: 007-243-07G AttenTiOtl: The PLT,-.[, Ult"ILer'sha-11 P;Ovidu a P,-Unp Lmaa?Jation log to the DSD within 30 days of purnp ini, Jjatj,,.,, , a I