HomeMy WebLinkAboutGW1-2022-03357_Well Construction - GW1_20220314 828-6221241 p.1
1 oh 1519 05.43p CleeTwotsl WAIT DA111119
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d-Date t�'dl(e);Campletell: Wcii IDN, _� .. Fri.
tiu.Well i..acnflona
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ustrinrritrm•cmiyI OW.i jr,nr-Mad, radicale'MTALMhol3F,Rot—wa9v c'msrrnraianei�tnitc. YoumaynlsoattachadilidunntpmsIfneet_imry.
T`olgl well depth Now land suram— —7 n _Y�(R,) 2�- �r�ello: �thmit thtq tbttn tsllhin�days o!eempininn of cull
1�r mrr/Npfc lrrll.s lilt nlid�'�Ihc�djj/ernM(t+raa(gM-�m pnA'mM F(AIt1fA j Congtruµion to the l5ttowng:
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1).BaR'tinlediatnMCr I (!n.) 24N r1m1skC qR Wdta: GI st"Ofm to reviling Ole faun to Nte nddmft in NO
M Well rortltructian nittthOdC S� TAbove,also Auhmit one copy of fhla fbTm wUh(n 30 AepQ oY mnpiwlnn of writ
(i c.naaa"m,nix•.a+bfa, "'^�--'— ^•--•- CnnAtnt40fin to the fOROWinX
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fiiiWA'PRfi1t[:ppJVWP1LSt)Nl!.V: _-- rM MAITServAimi Ceamr,RaUfth,WC 2701006
}3n.Yfrld(Rpm) Mellfnrt of te91. 1 blcG Pnr Wgtr rSots&[ttrxdon_Wettt: in addition to somling the ftmn rn
tlrc mWrrs<ts) obwo, nisir ,whinh.am copy of(his ftiim whh}n 30 da"or
I.W.Ulsinfieetlnn type .,_ ,rlftnnret., campletion of woo COrGStfimoon'to the county hw1h depin4eeut of the C'minty
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Well driller SeWOrcut Certification
Nevkr Well:—
Pexmit; I DO 14LO
t heme'by m*tba the abm referenced wall-Am grouted in appearance in acmte>{zoe with
WI Cotmty Wev rulft
Well ft-Mer: Rel, MWd1"► _S g' _
crdficatec Zt Ir Dw.Grouw: 1 Z-30--2-) _
Constxuc don: clout
Total Depth; _ Type;
casing T�lpe: SIC Thicl�ness: M . d
Casing fit: Ih: -
Diarnew: ,\S
Drive Shoe:
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