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Home My WebLink AboutWESSELLS BK 1 LT 1-A-1Onsite File go Lot I A 'dor diff cm FAO.", OjwIh rormerly m&%A/Blk r m / e 9A' g 1 1 oa 172.53 \ � -1'j 9(roo'00"E Lot 1 op 24.99' I l 33,653 s.f. / 5' ELE TRIC NT EASEraENr CO Q 4E APAMEfdr I O / 1 86.9° ABOVE N - �•' ' ' �' O O 3.0'' ROOF OyERHANs I o 12.1' CANT m —1 16.4 _-- 1 zanon 100'-- ri N � 5g°0G°W �FASEkiENT E P TI W WELL LINE -Z -- —_ �� 01U$ _ < 33' ON SECn RESSERVAnONS I I ^ 13.7• .y .s. ,9 _ - � . ' -- __ /,—CANT __ • +-- — — CANT 7B.fr ^ 64. 5 5 1 2 STORY 1 63:1 6 N RESIDENCE 15' T&E EASIENT - LJ 00 O \ O O I6.8' s 8.0' ED TESTSEPTIC HOLE � CLEANOUT - to I I IAw 0\ Ln \ 9.0' x,11.5' GREENHOUSE \ / 35'1 BUILDING SETBACK N 89°58'20'Mf 178.54 0 0 0 GRAVEL DRIVEWAY SUMMIT ®RIVE t'_ :5 — AS BUILT _ X SCALE 1' ��O' P� 10-096 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 ng & ASs®ciates9 inc. (907) 52.2-6476 Phone5gistered Land Surveyors 907 522-4625 Fax �® OF. A kalanals�alaslca.nef / Jclangls@ataska.net p��••• `` •.SVT n Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ,~ /25/° jO// O i PID Number: 011-112-21 Name: Udella Wessells Wastewater System: [] New [] Upgrade Address: P.O. Box 90102, Anchorage, AK 99509 ABSORPTION FIELD Phone: Number of Bedrooms: [] DeepTrench [] Shallow Trench [] Bed [] Mound [] Other: LEGAL DESCRIPTION , Soil Rating: Total Depth from original grade: 1.2 GPD,Ft2 11 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: I lA M&W 6 Ft. 5 Ft. Township: Range: Section: Fill added above odginal grade: Gravel Length: 0 Ft. 40 Ft. Well: [] New [] Upgrade Srevelwidth: Uumber of lines: I Distance between lines: 2.5 Ft. 1 Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Existing Private Ft. Ft. 400 Ft2 3034 PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. D&T CONSTRUCTION LLC 7/2812010 GPM Ft. Ft. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: ~To Septic Absorption Lift Holding ~ublicTPrivate Manufacturer: Capacity: From ~ Tank Field Station Tank Sewer Line Existing 1000 GaL Material: Number of Comp_artments: Well 76.9 102.4 50' concrete Surface Water 100+ 100+ ~ / LIFT STATION Lot Line 46.1 26.1/ Size: Manufacturer: Gal. Foundation 4.4 12.9 "Pump on" level at: "Pump off' level at: High water alarm at: in, in. in. Curtain Drain 50+ 50+ Pump Make & Model Electrical Inspections performed by: Remarks: Existing tank verified, concrete BENCH MARK Existing crib verified Location and Description: Door Jam of Greenhouse Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 712812010 Development Services Department Approve- ---- Conditional Approval Date: ............ · ,{<!~. even ~, h'onnone:,o_7~ q Reviewed and approved by:. / /~/', / (i ate' /O, '-12 0 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS· 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE A~ACHED SPECIFICATIONS. 5. SCOPE OF WORK: 5 BR HOUSE UPGRADE SEPTIC SYSTEM, DEEP TRENCH PER DESIGN PARAMETERS, VERIFY INTEGRITY OF TANK. REPLACE OUTSIDE WELL RADIUS IF LEAKING. 4-. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 17 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. UPGRADE FIELD _-32..'__~ 6.0'1 zO~~~-~Draln rock 6" above pipe inv ' I t ~ 4' dlam' draln pipe s~ 5' I rock below pipe inv. ~Droin --t ~-2.5' -17 ~ No groundwoter monitored SECTION i /'-(~G/~G) 4 (~G/~G)/ ~0~.9 /9.0 - O0 ~ .......... · .......... -[16.3 :~%%~-~:.~:~.~t4--~5.~.~;~.~¥2~i~:~.:~.~;.~.~?~;~`4:..~.~-r~¥:~-7;:%~.?"t.~.: 90.4 DEEP T~ENOH SEE DESIGN PARAM~EES PROFILE DE'ION PA~A~ETE~ ADD~EVIATIO~ LEOE~D NO. BEDrOOm: 5 (~50 QPD) CU COPPER ~u u WATER LINE/ PERC ~ATE: ]-5 MPI (] .20PD/SF) DIP DUCTILE IRON PIPE WELL ~ADIU5 MIN A~EA ~QD: 575 5F TH TEST HOLE DEEP TRENCH 5'ED (]OSF/LP) FO FOUNDATION CLEAN OUT sss ss ~ EXI~T'D SEPTIC ~IN LENOTH: 58 LF T~ TANK CLEAN OUT NO. U~E: DEEP T~ENOH ~0 LF 5'ED, 2.5'W, ] ]' TD C~ CLEAN OUT NO. m m NEW SEPTIC VERIFIED EXISTINO TANK OONDITION M~ MONiTO~ TUBE NO. ~.1. ~IOID IN~U~TION ~ CHNNLINK FENCE DCO DOUBLE CLaN OUT DV DIVESTER VALVE F5 FLOW ~PLI~ER NOTES: RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510~.~... . 9/28/10 0~-~2-2~ UDELLA WESSELLSf,-~'~" CE 8149 '~ PERMIT NO. P.O. BOX 90102 f~_¢...../~.~~ OSplO~O~ DESIGN NOTES Anchoroge, AK 99509~ ~w/~~~.~% ...... .,,~'~ Sheet , / / I Lof 1-A ~ i ~ /--GARAGE (E) ~ ,o, ,-c i Lo. I ---I ....... "-- .... b - ~ o ~ ~ ~ ~ ~:~ --~--~ O~Z ~ ~ ....... '-----~ ~ ~ :U~..~ ~s~ ~co ~ ~v ~ ~ .?,.w' NO WEL~ZOR SEPTIC UPGRADED DRAIN FIELD CP~ ~REUsED CRIB AS RESERVE (E) ~85SF/BR x 3BR=255 SF REQUIRED ~ __ ~ ~"'~*Y __ 6'x6'x12' ED=288SF ~ SKYLARK DRIVE LOTS UNDEVELOPED T1 1~'5 IBD'4 NO WELLS OR SEPTIC CB ~,~ 33,3 ~V t4,7 34,3 / H1 13,B 49,9r · C4 5i'4 88'9 J~ H3 47,9 NOTES: P~O~ ~0 ~C, L~ ~--~%~, -~ Date ~ 0~. ~L-'~, g/zs/~ o PHONE (907) 272-8218 FAX (907) 272-8211 Scale ~ ..'~_.~ '.., ~ ~":so' i"~~:' ~ ~.,.~. ~o M UDELLA WESSELLS ~ ~ PERMIT NO. . CE 8149 .'~ 0SP101101 PLAN Anchorage, AK 99509 ....~z ...... ,: Sheet Permit Number: OSP101101 Tax Code Number: 01111221000 Work Type: Septic Permit Effective Dates: July 14, 2010 On-Site Wastewater Disposal System MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 EImore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to July 14, 2011 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: M & W Site Legal Address: M &W BLK 1 LT lA G:2224 Owner/Address: WESSELLS UDELLA P PO BOX 90102 ANCHORAGE AK 995090102 Site Mailing Address: 5429 SKYLARK AVE, Anchorage Permit Lot Size in Sq Ft: 33653 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchoraqe, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 .http :llwww.muni.orqlOnsite Development Services Department On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** WR#: OSP101121 HA#: Permit: OSP101101 PID#: 011-112-21 Legal Description: M & W, Block 1, Lot lA Engineer: PES Applicant: Udella Wessles Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the slope greater than 25 percent has been approved. The approved separation distance is 10.0 feet. This waiver approval applies to the existing absorption field to Error! Reference source not found, separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted' /' ,,/Name of Reviewer- Rec#: 099347 Amount: $200.00 Date Paid: 7114110 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 wwvv. muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION ,~.'C~£/¢ ii ~ 1 FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-112-21 Property owner(s) UdellaWessles Mailing addressP.O. Box 90102, Anchorage, AK Site address 5429 Skylark Drive 'kc Legal description (Sub'd., Block & Lot) M &-M-S/D, Block 1 Lot lA Legal description (Township, Range & Section) Lot Size 33653 Day phone Zip Code 99509 Zip Code 99503 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR ([~ all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. C'--~ ~-'--,,Y-"~ Pannone Engineering Services, LL~(" (Signature of property owner or authorized agent) Permit/Rush Fees: ?2 3 ':' Waiver Fees: Date of Payment: ('_~. ~ '~ q ~ / ~ Date of Payment: Receipt Number: ¢ ~ ~' ¢ Receipt Number: (Rev. ! 1/05) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com June 29, 2010 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: M&W S/D, Block 1, Lot lA Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The lot is served by a private water supply. The existing septic system was installed in 1965 and I was unable to locate the record information. It either does not exist, or it is filed under the original lot description before the subdivision (I have been unable to determine the original lot description). It shall be inspected and the size verified. The existing tank will be exposed and verified for size and condition. If the tank is leaking, it shall be abandoned per code and a new tank installed outside the 100 foot well radius. A new drain field will be installed west of the existing house and will be sized to handle a three-bedroom waste stream. The surrounding developed lots are served by private water systems. The private wells are located over 100 feet from the proposed soil absorption system. 1. Soils. A single test hole was excavated by PES on June 8, 2010. See the attached soil log. Ground water was monitored for over seven days. No ground water was monitored to a depth of 17 feet below ground, level after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used, using a conventional wastewater treatment system. ge Soil Absorption System Design. See Design Drawings sheet 2 of 3 for the design calculations. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 10 to 15 percent based on the survey information in the area of the septic system. There are no steep slopes within 50 feet of the proposed septic system. Mailing: P,O, Box 100217, Anchorage, AK 99510-02t7 Physical: 615 East 82® Ave, Cu[te B6, Anchorage, AK 99503 Telephone: (907) 272~82:18 FAX: (907) 272-8211 Page 2 of 2 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and there are no further comments received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. OwneffCivil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 615 East 82r',d Aver Cuite B6, Anchorage, AK 99503 Telephone: (907) 272-82:18 FAX: (907) 272-82:11 J Lo~- 1-A 2 ~ % Lo~ ~ -c ~ "Tm'. ~ m 2 ~J ~s G~S ~T ......; ..,,....... ,.......,.~ ~ ~ o ~ ~ '~"'": ": ':..'"?." .... WELL (E) / ~'t['.;r~ VERIFY INTEGritY. · ~ . .~: :.-~ ' ~~ ~ NO WELL5 ~/~ LOT UNDE 40LFxS' [Dx2.5'W,~ ~ ~RIF~IZE & REUSE j LOTS UNDEVELOPED NO WELLS OR SEPTIC g NOTES: P~O~ ENG ~C, L~ -.~ OF ~L-'~i, 7/~/~o iSSUED FO~ CONSTRUCTION P.0. BOX 102954 ANCHORAGE, AK g9510 PHONE (907) 272-8218 FAX (907) 272-8211 ff~' ~:~l~ Sca~e M ~ W BLOCK 1 LOT lA .......... ~ o11-112-21 UDELLA WESSELLS ~nnop~ PERMIT NO. PLAN Anchorage, AK 99509 ~ 1 OF 3 SPECIAL PROVISIONS 'TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3 BR HOUSE UPGRADE SEPTIC SYSTEM, DEEP TRENCH PER DESIGN PARAMETERS, VERIFY INTEGRITY OF TANK. REPLACE OUTSIDE WELL RADIUS IF LEAKING. 4. GROUNDWATER iS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOiL TEST HOLE INFORMATION ABOVE 17 FT. IF AN APPARENT WATER TABLE tS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. UPGRADE FIELD / ~0 Drai .... k 6~ above pipe inv I t ~ ~ 4" diam. drain pipe - ~ 7 ~o ~roundweter monitored SECTION 4 ~ Dia Peri Pipe DEEP TRENCH SEE DESIGN PARAM~ERS PROFILE DESIGN PARAMETERS ABBREVIATIONS LEGEND NO. BEDROOM: 3 (450 GPD) CU COPPER WATER LINE/ PERC RATE: 1-5 MPI (1.2GPD/SF) DiP DUCTILE IRON PIPE WELL RADIUS MtN AREA RQD: 375 SF TH TEST HOLE DEEP TRENCH 5'ED (IOSF/LP) FC FOUNDATION CLEAN OUT EXIST'G SEPTIC MIN LENGTH: 58 LF T~ TANK CLEAN OUT NO. USE: DEEP TRENCH 40 LF C~ CLEAN OUT NO. NEW SEPTIC 5'ED, 2.5'W, I 1' TD VERI~ EXISTING TANK CONDITION M~ MONITOR TUBE NO. USE NEW 1,000 G SEPTIC IF UPGRADE R.I. RIGID iNSU~TtON CHAINLINK FENCE !S RQD DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER ISSUED FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 ~ ~xr.. ":~: PHONE (907) 272-8218 FAX (907) 272-8211 ~...'~o '... NTS NO 011-112-21 DESIGN NOTES Anchorage, AK 99509 ~I~I~s~%~ Sheet2of5 SOILS LE}5 - PERCDLATIBN TEST TEST HOLE ! 1 -- FILL SAN]) 4 ~-~--~'[ ~AS GROUND ~ATER SLOPE i4 -- ENCOUNT~RED? N i5-- IF YES~ AT ~HAT TH i 16 -- DEPTH? DRY SLOUGHING E X i7 END ~EPTH TO ~ATER AFTER BBH LBDSE SAND M~NITBRING? DRY DATE~ 6-18-10 I ~ WATER READING ~ DATE CLDCK NET TIME LEVEL NET DROP TIME READING i 3 1:29 3,~5 I 4 1G9 10 NIN 8,5 ~ 5,B5 5 6 B49 10 MIN 8,5 5,B5 PERBLATIBN RATE 1,9 (rain/inch) PERC HDLE DIAMETER 6 inches TEST RUN 9ETWEEN 7 FT AND 8 FT COMMENTS: Test hole excavated by P~none En~nee~ng Svc. Test Hole was preso~ed before perc test. TEST RAN FOR 1 HOUR. LAST 3 READINGS REPORTED. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. ISSUED FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 M & W BLOCK 1 LOT lA . 011-112-21 UDELLA WESSELLS ~, ?~eve~R~a;n'~i~ PER,,T NO. Sheet SOILS LOG Anchorage, AK 99509 I i WATER READING [ DATE CLDCK NET TIME LEVEL NET DRDP I TIME READING 1 6-08-10 1:18 3,25 2 1:28 10 MIN i0,75 7,5 3 1:29 3,25 4 1:39 10 MIN 8,5 5,B5 5 1:39 3,25 6 B49 10 MIN 8,5 5,B5 1:2 PROPERTY LIN E ~, 1(18 - EXIST'G SROUND PROFILE 104 ~ -- 25% IN~-ILTRATION LINE ~ <;AsF'ROPOSED PClNT OF FIRST POSSIBLE EAY-LIOHTINQ SECTION A-A SCALE:I~- 1:20 V-I:~ 84 ~ 1N'40 H4B0 11~ 00 10~,80 104 60 / / ~om~s: p~o~ ENG ~C, L~ 7/14/10 PHONE (907) 272-8218 FAX (907) 272-8211~.:~9TM ~ .~, ScareNTS M ~ W BLOCK 1 LOT lA ~~.~01~-112-21 UDELLA WESSELLS~~¢j ~ .... %~'%,',] . ~PERMIT NO. i~ ~.. CE S~49 .-.¢~ P.O. ~ox 9o~ o2 91¢~._.. _¢~... ... DESIGN NOTES Anchorage, AK 99509 Sheet ,~ 1 OF 3 PROPE 7TY LINEx~, i EXIST'G ~GROUND 'PROFILE ! ! 1~o / , ' 25% INFILTRJTION / LINE Mi - 9~ / /' ~"~~ SAS POINT O- FIRST POSSIBLE DAY-LiGHTING 3' FR(>M 25% INFILTRATION 7/ LiNE ~ SECTION B-B i ~ SCALE: ~-1'20 84~ t1' 40 11- ~0 11~ O0 10.80 10~}60 ~~ ~ D a t e ~OT~S: P~O~ ENG ~C, L~ ~ ISSUED FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 ~__~.. PHONE (907) 272-8218 FAX (907) 272-8211 ~ · Scale UDELLA WESSELLS P.O. BOX 90102 ~¢~' CE 8149 .~ DESIGN NOTES Anchorage, AK 99509 ~i,~;'-~{~p~b~S{6~.''~ Sheet PROPE RTY LINEx~ EXIST'G SROUND 'PROFILE lC4 ! ! ! 1{'0 / 2570 INFILYR)TION / /~ / PROPO', ;ED - 93 ~ ~' ~ ~ SAS POINT O- YI~ST POSSIBLE DAY-LiGHTING 3' FRC>M 25% INFILTRATION NNE s~ ~ SECTION B-B SCALE: q-1'20 / Mar~ Begich Mayor Ocv¢lopmzn~' .~¢rvices Deportment Buildin9 Scfz~ Division On-Si~e Wct~r & Wcstewoter Pro?~m 4700 Br~cw P.O. Box 19~8~0 Anchorog¢. A~ 995[g-6650 . Pump Installation Log Well Drilling Permit Number: SW ,nrcelldentification Number: Oll-II~-~[ Date of Issue: o Legal Description Ad /3-1 Pump Installation Date: Pump Intake Depth Below'fop of Well Casing:/~Q~ feet Pump Manufacturer's Name: Pump Ivlodel: . .-~ Pump Size ~ hp Pitles~ Adapter Bu~ Depth:~ ~ feet Pitless Adapter~Manufacturer's Name: Pitless Adapter Installer: ~/~ Well Disinfected Upon Compledon~....Yes [] No ~vlethod of l~4inf.eqtion: Commenm: Prol~erty Owner Name & Address: Pump Installer Name: Attention: The pinup ir~ta[l~ shall provide a pump installation log to the DSD within 30 days of pump installation.