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Campuses:
WW-06946 Reviewed 2008
Name of lake or river:
Property address:
Fire number (if different):
Legal description of property (township, range, section):
Year well was constructed:
| Depth in feet: | Diameter in inches: | |||
| Casing Depth in feet: | Type of casing: | ____steel | ____concrete | ____none |
| Pump location: | ____in well | ____in basement | ____in pumphouse | |
Name of contractor who installed well:
Dates water was tested:
(Insert water test records in this folder)
Location of any wells on this property:
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