HomeMy WebLinkAboutGW1-2021-04107_Well Construction - GW1_20210823 82822�?2h1 A.1
Ff% 1519 05,43p ClearwaterVlleit Drilling
wE L q y&xj0u)EtE,co !GW it s^nr lntrlmnf UAe nly:
r•WrMA' ntraetar lnrore»alton:
tVrtl CntnZrapDt NfRm,r /�, Fnatrr ? —
A
(VC Wrll('nnMgmCatlfiaMion Mnnto. 1111 wait a
?..1Ycit Co»rtrnefian FermH#: �
r.IslaN np/rlrt7rhrr.tom!rmurraalo»/>r rmnc(/r_ula Gamxy,5[alr,Yarfanca m:J t9, to In.
3.�Yetl 11.�t:(check wdl nse); R. !F ta. ._-
rN
r SaPldy Wil: ?
Th
tcttltnral tfilclpal/Puhlic
thctyrtai([ieating/Coedidential WRWSnppiv(single) ellq►riallCmnmsrautf Rcsidcnftl WatarSupplu(aboreg)ntion T A'►ater!ltrirplvtLella tritorin8 ion Vlell ft-
ifcr Recharge [3Groundwatet Remedisliunf�rStgraADand2ccnvcry Salinity Rattier aasttoaferTcst MStnrmwawDrtdnagt: (Lrimenlal TWlnmingv r3subsidenat:Contmi 11.hertnai(Closed Lnap) DTVkCcrttr�nR! Neatin Cnotin Raum 01hv eft lain tnldcr il2l Remarks) v
-�—•--------�-----••-�-- tr. to
A,ilatr..}Vdl(a)ComplMRrh,u`de[C'Well IA#,...- ft.
WcIll,araHnn:
],:inl rfkwxrNgmc fntilityttht(rf+grplfcgDlr.) Q. R
emnt Areas,C r V.and Zit+ ft EL
C:aunty frarcci rdtaniIIrntipn No.(PMMj
°il►.t,nlitndc nntl I010tude in degrnnfininutestsecands or decimal drgreast
W-011 f pd,nne tnNlnng in ardyw nt) m tifttltf n:
Wb�?'-03.,A v M G( G 135.E I
6.b(are)the well(R) Fermnnent or Oremporary s,i mr erC7attficd Wdl otteaator pate
MMW in
-in thh,rt repair to nn cubtlug wdl: MNas or rya ag,1 jS�yr a7 n C.0 on nr rsA Nf.RcWr rtwdho Wet)C rn rir:armamov owl 11M,1
fr'MdsLenr rrir.•/Jllmnknnxmtoafl v�stnrulnnJ rmallanmr erprRhrr6erxrrnrr"Pha 0MPvnfllrlchmrit/�aF�i>7 �1�►VdkrffilM!WrIIMNJrr
r.'�++tr ender A)/rryyyre scclMn rMantln7 hack r flhtx jnrnr.
23,Sft dtetgttt m or nddi tatttt Wlit dt1lgliit
R.l%nr Geraprobcl� pT or(land-L*np Geoibermnl Wtlb hnvfng thee You may use the tutelt of thtapage to pmvido adtl3imtnl tvdii Bite dandle rn•ure11
,x n9lmctinn,aniR 1(.iV►-1 is needed. rndirrtto TOTAL NUMBER of+vrllc C-MAnteliotl rletaits. You may aim AftAOh''addif)ttnat pages if rlemnrv.
T11111 well depth below land sunbee:—_ •J V . (fl)
rnrnnrrop�rrascr�rallde�nwrfdtYjrr+tar fiurrmpla-t(n1J4tr.ma rdng $%. 6or•AR W h: SllhM t this farrn,tivithin 30 tlat%of ectmVICUon of well
D ranofmMion to the MMcLm
aQ•:Metin watts tvf Co Itetolr top of casing: (ft.) DiAlon of Walar Re amreca,ItoforrntWowk
1,f a4rh r 4.nrr!la•nlmmr tm/rr�.tree"• » t'rataRft11MFr
1617II'htil5fe>vicacmtrr,IbtdghrriCa7k�1-t6t?
ti_l?ltneliateAit►tttaMr, b (in.)
Mb.Aar laier�,W,dF ?u addition to`Aending fl*form!p thtt uddM in 24n
I MR eomatrnetron method• YC��[�tiJM1� ttMvr 0M Submit one copy of this form within 30 der. of numplaorm or wdl
rr°•'"M--mratv.cable,direct ixtttt.etc•) ^^^�^ rartimortan to the fallowing:
f
t�fR WA 'R SrlrFt v WR,t A ONLY: Dlvhlon of Water i emuircM Undmiround itl(ectlon Cm"PuoMm,
1636 Man S umbe Center,Jl0f dgi,NC>71ip9-1G18
i to Ylefd(gym)��^ bdethrut of tesn Rite Par Willor Sutleiv&FAfaeNon cyNre•
in additf(tt to 9attding the tilrttt m
1.13h.M.-unf"tion typo: AmmmO vie addrtras(es) above, Also submit One COPY Of NO fbfM adihin 30 day;of
�- completion of Roil a►nsut "DA to the crimpy(Bald)dglamnt:01 of tits tanmty
t+vhera a►lt4ttacmd.
r+non CVJ..r
— � 1Jcvl1,!'.amltnnfSat,nrrmonr.of i;n.•lrmrmrnml Q7mnn,-rXvtsrnn o!.'Water Rn9mtrcex
----------- Atauftetlz 22-2Atr;