HomeMy WebLinkAboutGW1-2022-06941_Well Construction - GW1_20220601 SELL EON�TRUCITON RE GW—I .
L Wan CoalrsetorTaformatioac _ ForE Use
L
F80M 1b yDES�IPIIOPt- .
- � 53 S .. otti• o $
NC—wen CoffisaorCet R
-1£�II'ggCA.BNG s�'mo�g.�-�-4rcgs o$ _
M
LW,a Cosvh aetloapetmlt#: V!/ d ��7' FRDDz G1.SIIdGOR1•�HG'.. ca:'�,. n.r�•. .
�p (a�'°IIaoraanabnPeraarslz��� ^c--y-Sm4 Ymimxq da) $ t t6L~!y
3 WeIi4�se..�(ehheckweIIuse). 5 701< m" 7h i rk-
Yt/
Dad+E/+�S ;WC�: i7.t.- ."d.'-i'�._1-.mil�_:`N-•:.•��Fn4n:w� ��?;.0`.�ti i •-'ads
�' `�..+++++su yf y D7A�P8 S1.OfS'Q� •• .
❑C ($�ag/Coolmg ScPPdY) �tideatial WattrSttpPty(�g1e)- $ ia. ,
O1ve=meezal ❑8tsideatisl WaterPP1Y C $ '�-
fl 'm OWdls>100,000 GPD �QtO17i c.: 1_ - :•,:.-%_n ice_�� w±�:��::•s::
- -Waterb1wjwWeII: TO: r zr►c- xr one om�rr
• OM .R �
S CReeovety •t
• r.1 j5Cjj8Mj;5 CCmotmdwatergemuHad n $
OAggf=s tageaadRc=m:g, OSelh�iyBeafa - r S91�IDItRtAVSLPAtDr.£ � iCs��, �~ � -._
QAgai&rTgY TO vrrv�r r Z lS1@fTTdS�9D
OSaam�ataD�e _$ g
O memtal Tecbanlog r .Osnsd.deaoe ccatrd $
Of3rmtal(QosedIooP) OTiaeer =20rDgII.LiDiGFA .
OCNCaoliagRedna) ❑Other(a�lainta�der2 xoa"'at'
IL
4.Date Weil(s)Competed: 5-2 S_2 z. Well Mg $
Sa.WeRr ocafion: -
fL
.c vi 12 y
Ca¢mxy •� Pmor17doaNa(P1N) _ .tI v ,}
5L T atctade sad Ioagihtde is denreeshamuLs/seeoads or dech=I
C¢22f .oaolarllaagis ) d
egreec
MIN
�j,•N � ' � � . , 2Z Cer6fieatiorti. .
W
// 2�.
6-Is(Rre)the wen(s): Letmaneat br OTemPorsry ,2 Signamie C DAM
atifieet`9i►en —
7-Is this a �'�� Ef°�IYIY > Cs)�ras frr++Q)eo+asr�dplaamriatonNh
repastosaeatHagwell:� 17YGs or l7Ko ISdXCdCOZC:0I00arlsdNCRCOZC.OZ00��Cp�ravtarSha�mrfsarai$aampy
IfthLrtsarspv!l;�IIaGl7law�ivrIIm �� the�mao=ofsbe oflldssremdhmbeatpwldrdm9iesreffo=niv.�rp�rimd�fll�LssaslararmrrbeLaekoftlasforat - 'mG
8.For GeogobrMpT 23.Se 6W=or adWoaI weft
o - opGWB=mslWeIFshwbgtbesme detatls: '
You may ase the back of ihf Page to peo4ide addtt cnd wdl j&
ccustucticE6MgYIGW--Iisneeded.3adicatpTL)TALNaMBER fweIls (add'See o7cei Itadm3mBmc}YcumapabozffAadditTmm1 agesif y
dared:
24 SI mn-rAL3I jFMUCIIONS
9-TotalweRdept1tbel wl=dstttfs¢e: 4.2d '
Fornzapf ls�r�rJsaaIIdepJatl (e -3 •m2dZ(oj70� (T Submitthis GW-I witbia30 days ofwcRcomplcdonpwthefonowhV.
10.StR&waterkyd bdcw Pe
to 7tis.For AII HIRC Oa
If> Jadis a ��of ( ) goal$osa to Divigim of Wafer Rruasaxt(DWR).
gym" ocessmgti&16I7.10C,MdeWg�NC27699-1617
1L Bor�hok ditomter. (�/0 {m.) 241�Rei Iaieetion Wenx Copy to DWR,Undagtotmd 35 ject oa Contra(JUC)
nn 2WeIonriction n v,C4 a*-.rown-b%degymB etro 2
P4
mo—gFtaomr,W16a3t6rMSttSC,RaalenigdhO N C 2L769e9-G16e36h e_r,m aReWnWellCoytothe
,... oat�y aavaonmeatat health dr�ent •
�Y
FOR WATRSIFPLY WET,IS OHI,Y: 24d,For Water Wefts du' _ over I GPD• tO.D
13z Meld(gpm) Medtad ofzrst: PetmitPmgtatn l Il MSC, C 1 11 ,.CCPCFTA
131L Dis&fxdoa type: Amount:__ _
Faun GW-1' -
NanfiCamlmaDgaenmeatofFsvao�oral QaalaY.Divimaof Wa�rResoQars Ravi9ed65-2018