Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
GW1-2021-00386_Well Construction - GW1_20211228
©d�llL`�IDF_NTIAL WELL CONS1RUI ON RECORD JI S = Nadh CwmV=Dgmtmcut andNetmal R Division of Water QuaTlty WELL CONTRACTOR CERTIFICATION# 24 ygL- 1.VM&COMIRACTOR: d. TOP or-cAsmG is _FT.Abmm Lsnd swimme 'Top of casing UmnlimMed odor below land sulfaoe tray mqm :il:n SAII a Vadance in accordanceVAh 15A MAC 2C.0118,. Mf@ii COnttdGtm iial Iumm @. YIELD(9Wo1`�tlLE�HOD OF MMT i',tt /VLlj iflt88 COniraCtlOr `/J Sin `�� �,�:_/I L'Ls. .��►G. £ _�� f�%�f aeqUM STREETADDRESS 9- WATM2DNEs ids)- Ft=n $' To S Rwn To 221 a-!t ag a n L o2 G)-7 F=_4E TO JX-8 FMRL-To Cdy Town State zo Code Flom To Flom To z CASING: Depth ly182TewihicbmSSANOW Area code_ Phone nu rAM 2.WELL RMFORMATKIW. Fmn_Q__To�_Ft, 6�8 58 P iG SITE WELL ID"WOmUq - /l A From__To Ft. WELL CONS-FRUG M PERYRIt AA Fwm__To FL OTHM ASSOCIATED PG MWO(ff bta3bieL ./1•� & GROUT: DepM Materiel Melhod 3.WELL USE(Chm*Appfcabie Box)Uomloftl] �� /� /1 AWkullwo Ra�U Flom�_Toul __FL 1" �'�jct Ilt�getiptp Omm .(fist use) _ FinaL _To F ---- DATE DRILLED //- /l- �-/ From To FL - TM COWLUM DO' AMD s. scREEi�t: > Dialneler SM Sme tlf al 4.V99LL CA6TrlT Ftmq_To Ft in. in. Myt n r COUNTY o s Frwn To�p1� bL in- �/�- .OL a$W 5904 r6l r wt. RAJ. 7©/49 From To FL in �- (Saeet Nemec.tawas ,Cmuffdy.SubdiddmX Lflt NO,MCOL XV CO" 10.SJAmDXMVEL PACK: I POGRAPHM I LAND SErnm: Dwlh 5¢e Materel Slope U valley U Flat 0 Ridge U Other FA_M To (ehw*appopriafmb,m* Maybein d� Ft LATMME � �?.. 9 mimes. or Fmm� - To LONGITUDE �D�fl� lt'v . 'K D 7 1 is a da:imal fasmat --From To FL sour+cm Jr GPS 0 Topographic map llmftn "G LOG (bw6an ofwe9 mustbe SWM on a IMS mWo map and From To FolTrlatiort attad►ed to this form ITrwt usbw GAS) D - S C1, ti 5- 5R r i jJn StL- cP_ Grccq;it 10 �ir¢ni7�c s1c�L 5.E/�.MLiTtf-reldommearmobusima.hera9�e+.eAislo�alea� 9V - .3D� n '��- FACR Y ID r1{ifappHcaSle HA1HlE OF FACILITY STREE17ADDRESS e_ CAjlorTown State Zip Cade aZ.� CONTACT PERSON e-j% n t c'S o h MMVNG ADDRESS L a&.2 S o t 1; a —1 7,ol ,.- 1_ Mort State r4 Cade Ama code- Phone mmmb" &WiELLDETARS: 1ooNate YCBMFYIVATTNt WBLWASOONSTEiUMWRIACCORMVMW ZZ i 15ANCACMVWULGON1S RLC110 GTAt�.ArD'MTACUPYOFTHS a. TOTALDEPiH: d D li£OOtrD PRQAItD TOT11EvvdaLLMAsz IL DOES WELL REPLACE EMSUM WELL? YESEI t r- WER AT LEVEL Beim Tap of Casio � FT_ SK'M /�>OF Wes- /���� DATE {Use'+'KAbove Top of( V {1 �/-4'I �d�• `i PRINTED NAME OFPMM CONS`MUCTIING THE WELL Submit 2w coal tD tiie Division ofVftWrQumftvMft3Odaym AW9 ftftnwMm lllgt, Form INA qmm?tll _ M 278119-1s27 Phom as MM TZf M5 eod S*s. RlRr_1 ,