HomeMy WebLinkAboutHERBERT LT 2EDevelopment Services Department
Building Safety Division
-� On -Site Water & Wastewater Program o � '
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4700 Elmore Rood
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r P.O. Box 196650 4
Mark Begich Anchorage, AK 99507 s A E T Y
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: 01 b - 115 - 0-(
Legal Description Property Owner Name & Address: �t
Pump Installation Date: // e -z
Pump Intake Depth Below Top of Well Casing: J feet
Pump Manufacturer's Name:
Pump Model: G N ) 2_5
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Pump Size N hp
Pitless Adapter Burial Depth: feet -ro p ow CA 5 IA.) G
Pitless Adapter Manufacturer's Name: /J.9 n1 ►`
Pitless Adapter Installer: /v O ta r:—
Well
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Well Disinfected Upon Completion?'lyes ❑ No
Method of Disinfection:
Comments:
woa ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: /�'� P r 330 EAST 76TH AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.