HomeMy WebLinkAboutBROOKSIDE LT 6Brookside
Lo1- 6
#010-085-24
Mark Begich
Mayor
Development Services Deportment
Building Safety Division
On-Site Water & Wastewater Program
4700 Elraore Road
P.O. Box 196650
Anchorage, AK 99507
(~07) ~45~7~04
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
Parcel Identification Number:
Legal Description
Property Owner Name & Address:
Pump Installation Date: t l'~"'/t~
Pump Intake Depth Below Top of Well Casing: ¢~)
P.mp Mnuu~et.rer's Name: £Cb ~C~zff'-
Pump Model: ~'O gCII ~St~
Pump Size I/&hp
Pffiess Adapter Burial Depth: ~ O feet
Pitless Adapt~r Manufacturer's Name://
Pitless Adapter Installer: /
Well Disinfected Upon Completion? s ~ No
Method of Disinfection: (~0~$n L ~ [~
~omments:
feet
Pump
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.