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HomeMy WebLinkAboutGW1-2022-01067_Well Construction - GW1_20220107 828�822-?24 S P'9 f 0)151905,43p GiealvuatcacWellDrfAln!� ._�_..— -� . ---_ W�JC.�ONb"rt'RUCT[DN�+FGUR�J'C_..��^•.a-� •Fnr intcmnt Use nty, i ,nntreetnrfnhltmaflan; _ %veil C'011rowlix Nslia" —f., C fN fee Wcn p'nntmtlM t'-ettlftwon NIrMl"- ............... p.enrpnnyNmm� � 6 •�---.......-- !,1Vr11 Cnttntrnafion f ermif N: � . �k idSr qif npjdfmhf r,tttlrf.MtgntclMAlr7trlMlLt l!•pt{/x.CnrrMy,Sbtr,Yat•rm+rr.,err.J in. - 3,Wcll INN(chtv.k well live): Agr',ridtttrnl arlialpAl�1117{l4 �? it, r (t. (n' �_--- ctctptnrrtttnt i13nAtht /f.:antitt}l9uppfy) e_•aidenUnt Witter Suppl}•(s{n&:) ft- indusirinU(`rnntneralal ResiArntiat Witter Supply,(shared) "fv QUr 1 1Vtprt-17 ntcr 5np(plY V!r.)1= {t4nnitnfln Rea,vety -�. (�„ fr.a.cello tt. R. AtluFtn•Rcrhptgr- ()raundwntet Rt nicdistino .a0• /NVKL f A n•-- T ; -.._.... Aquir�rstoregc And Runvery Snlinitytantrirr Alt ]!1_ it, AgtdictTrvi S[M1iNmt5r�tatpn�o �' Subsidt ncn Content n' 13Nprrimen►nl TeclumlrtOy �� .—'"'"`""— .._'• _ Genthermel(Cloeed 1,rt80 �7Ynrec i.l • QG 1�.y31_..: C}ecttttcnoal lttaatin onlin Rctum (3fltCr t x loin u)tdat�121 RcmnrkS to �24it, it, d,I)Are tu�J1 t '' well fDtl ______._...,._._ Sa.Well{,nratinna ZDZD 2)0► k "Pa-....... •--.... ---------......-- Ti I�.ptilit�:'(int,crllpnnn finrilihr{E)ii(pfcmplirahlr.) _�. _._ _--•�, r�' '�n..',.�---r—_.-...----- -\ajzi-­w ,irvtlAdHrr.F.t.r:il)��anA7tr q7� ✓I W ����� ""�---• ----�^--; a: --_. <'•,prNy -' 11AW Idcntifir•Ation Nn.(PfN) ..._ ___.-- ..•.. 1,011nda ntnl tnngftndt In daRrocclmfnutn tcecnnds or dreipnnl degrroa: _ — •--�— - -- - ----•-•--.•.---•-- iiitMllfirld.nnr.lntQnnptiasniTitlaA,) O � � ---- �1;}. 1 Irflnn: //�� / •�� (13 11(are)the wtll(a) trfinaw or CIITr.IapnrArY ypnAturc n�Certifitt!We 1 CaAtmalttr Don h.t4minl,•opt". ,,rnr,1lrrw•hvrmrrj,rhea die twirf.,)tit plvav:)i-TW 1tM AS h)arrrprAMrc.r- :.In this.A repair to am exiipt(gg well: lfr,� nc, [JiVn «q;,'J SA.b?' 7f..Arlon nr i.lit rY(:Af.'119 V011A Aril(nrtrtrt+rtinrr!irnndordr mitt Map it If'rhi�;n:,rr�rnir„/111rnrtknni,mn,.A.a+n..rm,:ran+t/rijnrmn�lr<n'rarrT�,pinfndn•ntrp,rtgfrhr< 40l!Vnfflrftrrrnrathn,PhemPnitKnlQJnfhrwrflnwrtrr. n;rorr rnpdrr c?t r•rmprAs iacNMi rrt ctn iln�A?r•k offb(x.(nmr. , �;►�Silk d1altrtptn nr AtldfflllifOf patlldlMlMt R.t%nr G�nnrvrtt/llpt"1 or('ltr'ett-f.nnp(;etst6errnat Wells fpa�in!t ntc vnnic 1'nn n►ny use n)r.{mek of[jib psRC to provide sddiliottni{Heil Ant!dIE(Nifs fir cat it rx)nNittn:tfnnr Anl�i GW,t is rivrAcil. hidingto TOTAL NUMBER ofwrns con,911101017 dclails. You may alto ntMeh AQt►i(iaTtglpA((eS lfneCe.4.4My drilhul; . 1t�STR ICf10ti1R ►.lrnrnt welt dtltA bAlaw landsurl4ee: ��✓ ,fr. Ohl � Submit this farm tyl(iiin 30!fi{1s of coinplydon for wril i;:��+«lnt r:,rtr,��,.,,r;e.�n„•fern r,r»r���»rn/,�!(nl)pl�'nnd n 1P0`) r QilY1({IC#intl tO iha rollo%ving; i 0.9tntic:canny IL%vef nalnwr.tap nr nnnlpg.. ,— _ _ "{rt.) l3lvicinn of Vi star Relrnnrtxs,infntrmat}tm>'rnercuuit 11101, !1«rd,vh�,r)f�•,+lvroucnttnfi,,nc `• t C 1617MxRS¢"kt Center,Mdtiellb,MCT74"-iBf7 t 1.lintrrmteMiMmrtcr= �0 In.)1 Tar I�iceranw tilJella: to additicm intending the tamp to din ndAm mi in 24n I?-\VMi r�stnpl flnR method: 7 rd•rave.,nien Suhmit onr copy of this'farm+vithin 3(1 diVs n£rmnplWntr of wtti f�c.nnnr.^,raMR•.,•»(,tn,dirre4lnnh.Clc.1 � _.......� —T..{•.-,. ni mmictinn fn fhr,fallowin(r r AR WATI R --F —^ _......_, _.�_ t))v1ilon or Water RrAWAM.llnderAround Irdectbn clip"t"I f affrnm, lSt,ppt.1'�yF,A i.S AN1.X: ._ 16.'w Mail Aerwim..,centrrtl.Ratet(k.NC'�9Rit4.*G}6 130.Ytrid(Reac) -L�! iVtethnrl of tc!SI:�_ _ a..i:,�iAr�1rQ1,�r sn�et� initxNon'Wetto: Jn utiditila0 to Strtidiflg the ilNttt to _ cite rtddress(c s) ahnva; also sabrnit.nnc copy of thlS than within 30 deys OW13h.t/tstnfrrtlnn lypa:___ _ .A,tRmunt:-- r:nnnplcNnn ni well cnnsimcdon no the comet)Imailb depnnmrm of the onnnty ---' r,,rbnre aonalrncrM• ""'�'v''p NpphCnmlfrtn nmm�npnrt!..• �I+ r rttinmrntnir,,rwnnt�-rJivisurnoCWatcrRaennraaa RevheA?.7�-�nlpt