GW1-2022-08729_Well Construction - GW1_20220530

WELL CONSTRUCTION RECORD FarlrranalItscONLY:
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1.Well Contraemr information:
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repntrlwdere3lreumrisseveonorw.dsGa=lEofrhtrjomc 23.Site d"OgramoradditioDa1we11dNh®'Ifs .
You may ore the bask of this page to Provide addiksal vCH sRe defmis or well
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9.Total weU depth bdowland surface: Z3 (ft) 24a.Far AN Welts: Submit this form within 30 days of completion of well
For mardplesveffsIi ra9de dr#1drfffe rem(-mWL--3@=-d2@IM aominuctiontothefollowmg
10.StatiewaterlevelbelowtopefeasbW (ft) DivisionofW2twResomees,Wormflfoa.P—8dugUn%.
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11 Bmrholediameter: % fun.) 24h.ft faiectian WeJ ONLY: Iu adfdion to mudfBg the fame to the addeess in
� 24aa6ove,also snbmR a copy of this form with 30 days-6f oumpldiaD 6f well
l2 Well oonstirac6on methot>: I`l/I GliA- J( .. can7ftn Ito thefopowiag
("aus• •CO&-avaplak`t`) M.M.6 of vvades•sesnareQ,unae V-nd In sedan C-9-l Ptngeam,
FOR WATSRSUPPLY WELLS ONLY 1636 Men ServimCente r,RsleWNC276WI636
7stc For Water9mAy&h*,fi Wells
13a.Yield(gpm) ! /Z Method of test u Alm submit a=copy of this form within 30 days of completion of
M D�feefien type-S A ea' Amount: c7+T 0&i to the emmty health deprai�eat of the county where
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