HomeMy WebLinkAboutGW1-2021-03606_Well Construction - GW1_20210823 828.822-7241 p'1
f eis 1519 05,,43p Clearwater Wall Drilling
WELL CONSTRUt'TIUN�,CpRt��Gw"><1 T Fir lnWnni Um nay:
t.W�11 Cnntraetar tnfort[ttttivn: ]tlHs
y OCl
W01 Contactor hfptnt: i
MIL
/C�,Well CnnMclorCatifswtion Nnm'b r' ( f R C 1Pli+ Yiil
V
ebatrtwtt �
4'nmlMngNamc d' ��� OIAMC[EA
2.1Vc8 Constradlan Permit 0: � � �
i.7xv a/J np/r/7rnhie tralfcrxlstntaJlofiflOR/rgt(J.0.t/tC CnnMy 8tal�YaMamv:;err.)
tt.
3.Wdl Ilse(chtek wd]ose): 17.
�Muntcfp+°UPubi'ic _ ()
To a+
Eindussrial/CommuciFLI
ywcR: ty
(lieatingican] 3VPv) DReddential Witter Sapplv(Ansie)
i�n aReidciiWatesupply(shared) I L D
Nnn-WAter Supply Well:
A4anitoriltg
Injection c#
Agaifcr]tedtltlgc E(irmmdwatcrRsmcdist]on 'f9 HBLP auC
L
aquifer Storage trill Recavcry J3.4nlr�nity Barrier
AquiicrTect �gtorinwaterDrainagn R. rt•
Lxper]mental Teelmnlogy OSub0denao control fk LOG
Geothermal(Clased Loop) OTca= DAI
Qdtar,0111a(a ender f721 Rcrntuics ry it. A
CieotFterrnal(titattia ling luntm) V p^ IL s yL naAG!
.t.i)are Wtll(M1)
.ran.Wt11 li.ttcwtMn: ►i'� � � R. .. [t �++,.a.„�.�� _._
Fae+lily itN7(ifartplicgAtr. �
S•actltty!b\,71trNsmto !t i� � .;•� , —
oc
r�lty5;cst1 adntucltX.a r t�iJ tlu�s
Noreel[dautifmtion No.ON)
Si).i,tt itudeOno Ionpitudeindcgrw4lmlmttesfsecundsordecimat rtr.Rrccs: I 'rE dnn:
(il well 15MId,[me i8Ltlonitis Joiricicnt) b
-sippiturcofCkrtifia191diC�nnb'rtatar �� nranrAaacT
A.ifsNvO the wellwaip rmRatot or DTemparary r ,,n, hrtrltvoerr/fp AV:Ar%WH("J Nar ''� 7,hm,r
Fy emd
xfppIng Mx 1'
�+�i ��.�(( men lS,i tir.',1C.'Or*JjAO Fir 15 62C. 10 W idt Cnrafmrtinn 57andcnlF mrr
i.Is tlt(s a repair to An cxtrdag well' �lle5 or i�Nv a py 7r rr rord hosbtrh pin►
Iftlrlt ix:r rr�ralr.,(IN mu known tw.'li oaysanurron i,(jn,mo�lnH and ul+f�r'the uaturc nftfrc
r;t,atr render t,2t mmark=Iran arrm Um.hack t j/Als,(omt. ),, Sit,y ttso an or back
a t�Wh1!��t
1'srt may tree the'tack of this pt��prpvlda m(dilialal tvEit ail°dttloil+rtr we'll
R.fear GtmismbllllPT or CltttRd-LnuP Gedbe�!Wclis»twang thasnr+te
ct)[►otruction[lnails. You may also Mwh addlfional pays rPaaaeNitr)-
c0narntct]mt,noiv 1 OW]tt needed fnditxao TOTAL NUMBER o[wells �`���.* n�STRtttC7TONB
drilled ^, - lotion of v,ell
�R.) �� am A Ibtt SuM»R d► ftn within 30 days of wmP
9,r4#Al well dcpjA helow[Find sarfasct ca►nstiitolian to(be foirtm :
i:nrntu lop reweN.rUst at;ddWhvf (e:�PA-3620a'andit@1a09
p Dividon af�iater RAMIWcesalydhrtpatlon Unit,
111.IRA&Wo"Plevel Wowrep of easing: - ( ") 1lt19 iVhY Sanice CmtW,PIdd�b XCXFd" 619
Il'Mnferraval isr,/vtrecortng.roe " I
zti.Eta" aYd� ID add'tlion to AelldinB t11e lbtm ID dw�mt aP Wdi
II.Rorehoicdiltmetm (in') ,ti>ovc,81eo submit one cc"
of form wilbin 30 days
Of 12.!Volt emstrnallan mental: a>nstcnctiatr[a the faflttwinsl�
(i e.ma ,totata•.mbie,ttirect paeb,sea Divislon afWater tttamam%Itndeltgrotta�d tltj 'on Ctrttlral> ram•
w
,rj6Moil$'rakeCerI RtittiO.n1C2700-1636
F10R WATER St4PPT 17 WI+LL4 ONLY: r a.r.r„atiott Wdlt: is uddigan to sundhm the form tv
Methntl of teat: 2 tC bar Waror 3a--.. - of IbfM within 30 days of
13a.VirldlttDIItl the ttddtcss(m) :tbovo, also st:bmtt ortc copy this
comfidti n at�di 1O!to the comtry health dChatl/lletil of the cmM
t3A.01sinfectiontype Amntmt. wlxQerattnirtat "
--� � ReciaeA 2 2I 1al b
OW. Nosh G�+r+linnDePnAment of tinvtrcinm�mtal CZnnnM-f)toistan oPtttetar Itagotveas
'Mutt I ._.._._._....
f