GW1-2022-06501_Well Construction - GW1_20220603

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8.Tbr Geopwbe/M or Closed-Loop Geothermal pjreIls bavbg sbt:satnt: YOU may use fe back of Lists page to provide additional well site detasjs Orwell
wnshuct ian,a*I Got-!is needed,Indicata TOTALNtnmmi ofwas CDLStlucdM deWL.Ycm may also agach ad8itiottat pages ifm60asSM
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Farmu l welv depth below bind surface;_ Z4a.gt AR Submit skis form within 30 drive of temptation of well
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10.$iaticwater Level below bopof ( Division etWaterRemmvm,7nfon=Wmn Psvicessing mdti Ijw�er fever tsabove oasurg,use"+" 1617 AM Service Center,
11.8orebote dismcter: (in.) 24b.&r Inteadon Wells;In Addition to
smdIng above,also submit one ao the form to the address is 24a
12.WeIleot rneffa I m�ethad- i above,also submit
the One GlP of 8tis f�rn witlrfn 30 days of completion of well
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FOR WATER BUPPLY WELLS ONLY: Dlvlstan of tlteterHeso IIirdeognoaad7,decion�
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338.Yield fgPm) Method of test: ?AG BE WBIEC&=k.&bhMMjLeW fa ad&fwn to sending ilea form to
i3b.Dlsinfect8oa Me gym) shme. also submit one copy of Iris firm vd&fn 30 days of
types Bmo n c eoMuction to the county bed&depuftm*ce the=wdy
Fawn GW I Nmthi�toliaaDepemmeatofSavrmameotel
`+ OIIO Revised2-22-2016