HomeMy WebLinkAboutGW1-2022-06163_Well Construction - GW1_20220620 WE CONSTRUCITONRECa GW I) ForIatesaalUseo .
L Weu CMMMmIar Iaformatium
�'. , S . )'� t'_r; eA Gw 1�•w�Rzor>Fs.
wen C000ae=Zjw= - FRADi TODhS@BIIOH
5 3 5
�ilYn� �,c..� ���»zEa�►.m�rs s�-:•-...���. oR=ate• �._-
�-x�e
ZWenco + j+� ,n p G\.SQIGrORT0�2G =w-,� °„•. -
ZtaaIIneflOnpermll :_ da 2i !/ `T To
� S a/Y "L TA a c t 3,Welilwn�snwwtt(cbec wen me): $ g
Q ad�s�;Wes_ ��'R•L'�_ •fl�TO• ,a.-a::'.7�D�c��r�{���-.�.y��.wia :i?,..w��:_�r�X:.w fir.
ft
ST�rs1� r•
C ,IIIG *eca°,mssm*) A e e - Ww-rSnppty(fie) '
fl "oa DWeI1s>1 1 OGO/�}�YC�) .28.:Qtdvr�.: _ ,,...... _ .. :.:.•:.
t�D FROM _e -`}w.Y:' s Ss+s #• r
1�Ioa-Wi4rSappZpWelL• O To •`•"�T•, J rr►c�rrNMMODaAvomvr
OM rmg 23 eca#- t
Iujccdon WeII- ORacovery $ $ p
rs
• ti`�� - . CGmimdwaLerRemedieriaa $ �
DAjgfwSmsW=dRecovay DSdh;tyB sz9 scam vsi;Pac�¢ '�r.�aS�= ,
DAquw=Tear - FROM To MAMMUAr. ' xnansItsdwirM�n
13SLoDugao s DMfi3Age $ g
L TedmalOV 'CS6=1w=Cool
C*W&=I(QosedIAMP) OTraxr
C Cg CoobngRct=) 00ther(cg9=u ader#F21 Rem &) EMoM TOIL
4.Date Wu Completed: G ZZ WeIIID# $ l A
Ss wcuLotafion:
shvr iv -
• Far�y/O+r�,H®eG Fae7ifyID@(sfsp�Grahle) $ , $ '•,��i.'1'if•_�.il��•.^�:
IL
c—y v 1=eIraeaffi=ti=xa
Sb.Ltifitnde and Ioagidsde is d /mia>ttts/aecon8s or decimal degstea:
C��nttela.onehdloagasn ) 22-Cerfifcafioa:
6.D( )the well(s): ermanent .or OTemporary / 200 y ssga 'A Dsoe
7 7sthisa 81'�+sr�isrld*Dora;IlrEorrbe�rr�tsJ+►arfirrieJW�nrraedaiac�ia�ae11
repairtaas:erisSagwdh� OYes or 1�No ISdNCdCOZC:OI00arI5dNGiCO2C.0200�eaCW�toaSb�mdsaoiabaampy
Ifsfdrisargrdt,�IIo+ab��a�ar�brfbrmatmiande�TaOsrlier�o:ofihe ofrldrntimdlraeLgetgrovidrdio8+ea�e77oimv
rep��order 2lsemmtssac2lar open thebm-.tioftldrfarar,
23_Sift diagram or2d6donalwen detdlc
8.For GeoptobemPT or Closed-Loop Geo&cram Wells h"k9ft same You may mse de*e ba of this po$eto protj&additZood vmu o�aedmi fo
boa,�y1GW-lisax$ed.3adieTOTALNt1ERa£weIIs (add'SxOve�mRemacisBmc�Yeumayelsoattarliaddialpegxsax�g.
dared _ •
24.SIIBhITTALIlVSTRIICII®PlS
9.TotsIwaHdepthbelawj ndsmfs=- -
Foraadrrp&,.A raIId�prhr� aaCam�a-3@M'pe2@Z00) C�� Submittbis GW-1 nifhm30&75 ofweIIeompletioa per SefollowhV.
10.Statie w:terlevel blow top of easing:_ • w Cam) 24a.For AIL Weft Oagmal form to Dbiam of Waber Resau:ees CDWR),
T}+ lodtr ,ea�in$ sse +- 1 oaPmcessa�g'[nk 16I7MSC,.Ralft NC27699-1617
1L 3orehole aster. U 7l {m,) 24b.Foi Mikedoa Wdtx Copy tas DWR,Undesgno®d Meaka Control qM
P=F2mo l636MSgRale*6NC27699-1636 .
I2 Welk eonstnchonmethod _
CL4 +3. P��)_ 1< b�d h. /d1r• ,- 2c6ForWatw andooea-LooneeghermaRetmnwen='� tDprvumi nmnh depalmesact aComitywbae FOR WATER SUPPLY WELLS ONLY 24d.For Wstrr WeUs do - Mr 1 G&.cw%D.DWX CCPCfTA
13a.Yield bno Methodoftest: Pe�tPtO8�,1I1MSC, C 111
lsb.D1ton type Amok
FcrmCW l NathCemlmaD�stoxatofFnvno�lQmtity-DivimoaofWaLsRsxomsxs', Rvawa66.2018