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Lot 3
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Mark Begich
Mayor
Development $~'rvices Depaet'rn~n'~
Building Safely Division
On-Site W~te~ & W~stew~te~ P~og~om
4700 Elmor~
P.O. ~ox 196650
Ancho~9~, AK 99~07
(907) 343-~9o4
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
Parcel Identification Number:
()
Legal Description
*cox
Pump Installation Date:
Property Owner Name & Address:
,
Pump Intake Depth Below Top of Well Casing: /~)~ feet
Pump Manufacturer's Name: ~
PumpModel: ~OE--St! 17 $ g~
Pump Size ¢?. hp
Pitless Adapter Burial Depth: 9/ feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? ~,.Yes [] No
Method of Disinfection: ~./~
~'omments:
Pump Installer Name: Anchorage Well & Pump Service, Inu.
330 East 76th Avenue
Anchorage, AK 99518
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation Icg to the DSD within 30 days of pump installation.