GW1-2023-02457_Well Construction - GW1_20230404

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drilled:__,_•only I NUMBER tenets construction details. You may attach additional pages ffneeematy.detail or well
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I SG Division of Water Reawrees.laii►naatian I.Bnr+e6ore er. ��� 1617 Man Service Dater,%high.Ne 17699-1817 nit,
u.Well construMlne _ ••
• 2+6 Hor 1■hereto■w i-� to+tddntioa to as the tam to tits
ite. method'
above,also submit One addfesy in 2Aa
emu posit;tom.) ,.�,_�„ copy this form within 30 days of completion of Well
conshuction to the fallowing
WATERS■,' NUS ONLY:
MvisionofRaterResources.
I/ r` 1G3fi MIDI Service Ccmcr, lttl It�tt(bR Coning pjpgpatp.
FOR I3a,L :' - ---
cansuu((gm) ((JJ11 ,Vhticish.AIC27499.1G4d
maw at ten: 2rtG 1!nr water e..,>.t.•
tab ,aitm to the col of ads fotett ado theh county
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y
where eOttsft■eted K ■retell elep>dpe or Odlntt�r
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Vona MI
North cuotiratnepertutent of linvirbeihental Quality-ph/ism/ea water Resources r
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wail Dreier 5 -6 r of c•rdficatkan
Lei fosse,
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Owner Dor
Affirm/147'cS;i6trz9eA L.04(43()"1 Reg
nkereby certify that the above referenced wall vdas grouted in appearance in accordance with
all County Well rules.
wen Driller. kg. Rea c5toLos
construction: Grout:
Total Depth; tl
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Casing Type: She_e, ( Thirlatess:
°Aging d Depth: a
Diarnetnr:
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Drive Shoe:
GPM: 10
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