Loading...
HomeMy WebLinkAboutGW1-2021-00384_Well Construction - GW1_20211228 ��z ti, WELI.CONSiRIICTION IZosth Cmvl De a amdN�Rom'�on of WaM r QUAW CTOR CER'TEFICATION# ,,���•�,- WELL COPl1TiA . d, TW�CASR#G 6 FT Above,LSnd ` ,wd,L©OltiBAl T(ft -Mpofeadng � C2ssataoemsy> �'i�n. �� :i 1: ^ Si y •,f - a va�sos W aoonNance /� .� V+JeD Contracmc( }Name LD(�X— /--L-- ti OF TEST e,YIE /�O ��ups Wei Conuamr Nerve g. WATEEt2OKES(depth): STREETADDRESS aj,-3 j7 .tc e / F �To h 02 G sl- From TO -- ]FWM —TO C1y Town She Code F�asn To From q - TO----- Mme 7. cAss�: tom' °im"ew -��_ p C' Am coda- MOM rtttir�' FtOi[1�To � _ , �' � �l �e� �✓J�6e LVIEt1. ►MW- �� dw OTHERAWMIAsm Z . � L GROUR t t>asgcad 3.WELL USE Pw& t*UMM&MU From To FI `kwunhudcammend �,�► e S 7 %e, From To Ogwg (est lase) _ DATE DRILLED J 9 N — Ff°n' — TM c�tFtEo AMn � a. SCI�: t In- Fron1_---T10 is —.._ d.lflit:l!- TIONA: COUNTY �taM Frwn To t11- — In- CiTY: C i!S Ram TO --FL ht (Sbeat Names�miaeas. ,,,�•-,�,r `-'- t0.SANDI6RA►VEI-PACK: SimMalem TOPOGRAPHIC t LAND :SETTDI Dew fieSlope a Valley 0 Flat u Mfte,a ottoer From TO (djwXappmpditbw Mgbem Frarn TO tATrjtuD>= a.W 1 . (o min.mands o! -From T® FL inadecimd rosmm LONGffUDE _V q �}7. 9/ D I�.oRtl.te�s LOG LwiftwenongRade Sources A GPS 0 Topogtaplua> From _ To FflmMbo<► Oxwon ofweu mustbe amn on a UPS eopo►aaP and / S S D DescdpWn a edto thisfeum d'natus6Wg GPS) S.FAG11.ti'l-btacmaieart�ob�.1�a>3�e.eA is�orasea. FACILIt WWappt ) - NAME OF FACiL1TY - STREETADDRESS CelliarTam Smote rPCade 9n C�O�t��IT�AyCT�IPE�>R�S�ON� jl� r' ►, L oQ re- JD MAILING ADDRESS s (x rr• ►M r r• �'+c/c( YI - 7-3 S g 92 REMATUM ' ( Staie Lp Codelied 1. (�yotTown t i J�G>( � r i 9 - 222 5 o t„9 u s e✓ Am OKb-- Pion munber S.W9lOETAUS_ 95ANGAIC?L.VWNE3L- waiO� a TOTAL.OEP�i: d D ra�HAse� T° b. DOES WELL REPLACE EMTM WELL? YESO NOR( SMAWRE wEI.L coNTRAcroR DAM o WATER LEVEL Bebw Top Of Casing LLS-_ FT_ zo I ,f��'► (use+If Above TOP Of CMW P NAME OF RUCTNG THE WB.L submit go a dgmd to Un DiVls W of WZftPQwWW vMft30 day& AtIM M RW- Forma Ralo&d He 27699-1617 Phone Igo..MS)T33-TOiS . Re�r.12�I