GW1-2022-07117_Well Construction - GW1_20220729

1 e,h 15 19 05:43p ClealwaterWell DMIling 828.622 7241 P'1
WE;f,t CQNS'I�tUCTION RECORD lCW�l rnrinlcrnnl Use Only.
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r:W 17/1017d/r04 ,mlJmnmrMClien pimrrt p,C.IAr;,Cntrury,Srf,/r;.14M71M,cxe,Pa.)
;.Well.Use(elvek well oar.): R. fun In,
tVakcr Supply Well:
Agricuittiral �Mra,ialpol/Publia tt. .Yr. • � a
u:,cnth"MR](Ileating/C*,eTitfg 8appty) Residential Water Supply(singit) f I rt H tn,
IndusuriallComtrlFrciai Residentia?wAiersuppiv(shams)
iM lien to Of
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Nmr-WatcrBnppljr
yl►'ell: -
Morotorinq Recovery n. it
Nijcetina Wy 11
Aquifn-Rect,"c
�U('QtIRdt9ntCrRGrllCllinlilln -A 3CIalufto
SAAIt1/QRAVBLPAAquifia•Srnray.nnAReenvcry U%linity Runner
nQultc r Test M4tormwater nreinallc tc, n•
l xperimt:ntnl Tachrtololtyy DSobsidenut Control rr. tl.
Geetherrnaf(t^lctsed T Alsl►) �7tacc� M DRILl.a fi.OG
(leothextnal(sleets oolin Ratam) Olhor lain under 021 Remarks)
n. ra
tl�t�ylrelt(ri)completed-, well iMt (t. I a" .
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ff.�V%V:X
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Pae;lity;'(ItHr�NRmR Facilltytt)Iel,fnpPlicnbrs) h. tt,
tj� S L �M.
nr/hwicRt Arlarce.C11y.and 7.lp
+.ire
.NAPrsI Ydtunftieetinn No.(PINT - I fl- � ram'__: �,.
rat
:ih.i.oNtucie and ImnRtrade Indl�'txaS/mfnatcs/serendsordcc(r,at tlr.Rree: VM'rAti!`/10ffAvrOG
(ii�H it flelrf,one TAtgnnrtiR RuTlieie„t)
f,A(g ra)the well(i) Pet MUM
qr�ITeatpat'ary plc afCeniFed Well GYmtraetor flee
7.1!,Ihts a reppir fe an nxtatltrp well.
�,,[ !3Y a'tllnrn�rhls,(orn,,f hrrryJ!1'�,r(Jy dwl'he nt0i to/tr At+e�)ro,ttt Odd Rtw,raWncc(f'fhlt is n p.�nlf, JJ,ut QYCS nr lZUNo ,vilh,'sr! p7l.'.A1fN?RW'I.SA,V(,AC.1Pl.C..I1206 A,r!,Gonclrnrrirm SYmn+4u+�c
r;�'+IrG/tdrrh 1:7 r R7IAWAWuJldf.Vlxllrrc7inur>t/brmvdr,n �.xr/oh,the 12maregrlhr. n•�nou 'nflhftr'cirrrditair eappm,ydeMffhmeW1.11 aa; �+�rt
�l Y°'nrtrF°""af?ar Oil f/R,low efilJxfomm.
R.!or Geoprnhr�►1 21 l9(fR dflMgrtM1 or Additional Well deW4ib:'T or C.10"d-Lanp C.eathermol WOR having Ihr:game YA31 Mily use thr:Lack of this page to*GvWe addtitioegt yvell slue detach ur u+et)
,x)WRITliction,only 1 C'.W-1 is needed. Indime TOTAL NUMSFR nf+vritc coaaui,ctinit detRirs. YounrAyalso itkaci>.Rdditi�tel
drined; pngrar ifnr t:eggay,
4.14tztwell dr� � . ,�`t RMUTAL iNM U('nenita
l;rir Atl,below laad4ut'Taoc; ,
mulllprclerNt1Arnlldrplht•rvarcrenJ(t�m„irJc.3(f�tOR'nud' IDD' —(�) 24a..l'dr ntl VJ�tlo: $pl,nlftthig
�-•-- ftm Wiglin 30 doss of cnmplaeon c,f well
Tn,Static w onnsir,u:ligR to the ildiMM":
serr levM1 brin»•iAp otonaing:..__ 'J! nldr irmrJla nikulr cA,p .ux9«,I.. Division orwater Reo# MAl,llliftrMation PrWaft
1 t l
%rehotr dtametcr_ 1617 MnII Service Center,''itaaf b, t1�t,
'—`=-.:-�.,.......(In.) 9 JVC27699-Ntfit?
?.41a,IFnr Ifaiec'nn tVeil>a: In addition toIr tiding the f0m ip the pdd�in 212
tZ Welt rnn�t�,bla,d mMthoti; L� i
(r r,,nugrr.;n�ttr)•,r�bk,direct pi,sly cis.) ain)va,also tlnbtnit our.espy of this fan'within 3p
-"""'—~-^ e0111trustion M tttc Allowing:
I 'rampiWan of self
t»g WAiT>rRSt.:PPt,1r
W!>LLc4 oNLV. --—R '-- D11,1910n of Water Itearnurtsay Unde
136.Yield 1� ,/ r@�A1010.tld N Injection Contras PragrAm,
U3t►m) i(J( ifi�lS Knit 3atvtee l`cnt ,RataFab.NC Z?6gA-11fiJ6 r►tetAodoFrest:
►;A.i)Itinfection type: — the srAdresa(cs) nhnve also submit one �� in addibtm la acnding at Rain M
Antannt: he stdrton res)of if eonrt�on to copy of This Ibmc ",lMn 30 clayx of
Por,u GW,i
wrmrc romIMC". Nu cat>'fi°alth depatrgfaat of lure cpnnh,
-. __„--•-- w tJertlt t;Rmlinn t>�,nitment of Nnvimnmcntnl QuRlit�••rltvi,tfan of tpallr ltnrtatrl!at
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