GW1-2022-03358_Well Construction - GW1_20220314

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928-622-7241
Feb 1519 05:43P Clearwater Weil Drilling
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sxtnv�naalion,only 1GW-iisneeded. lhdicato'r0TA1.NUMSF,itnrrrl)s tml9tntufnndrt�e(c. You may also attachndditianalp ifnece�a
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�h VOW well depth holow land sat£+tcc: �u (ti! 2 or_AlI Submit!this lbrm wilisin 30[lays of complclion of well
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11.0orehole diameter: 17 On., zth.w1jection 3WL19 In Lion to smiting om farm tq III Wiwi in 24a
otmve,ails sahmit one copy of this form WNW 30 daps of emplatim of Well
Iz,WMI cnmmieli m method; colometina to the following;.
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JI WATER AUPM.1r WEE S t1Nt.Y: —� tfw461m an Swvlee Conmr,ltelI WC.276W1636
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the as lam.%Ccs) nbove,nfsa submit one copy Of Bits £*slit witlsin"days nF
i3b.Disinfection type: Atstl►tmk epmpletion of,vaii cwmutttSson to the county tloalth depitnmap of lilt cmmty
= �i> oistt imeted.
irtnm Ctlr-1 TtorrhCaroltaa[?epnnment of timtrdnuttrtal QnAltte-rstvisinn of tVaret rta'mnrr� Revised 2�1!-•2RI b

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