Loading...
HomeMy WebLinkAboutGW1-2022-07236_Well Construction - GW1_20220805 r, + MULL Cd�IS�'RUC'no.N CORD M #,� For rntmnalUs0on�,ji:� •; R=t.�»:t.:, 1-17M c�traabornPormafiorn IILWAM ZONES k 1 . 1VBII CoebectarNsme . 70 =mmvnIi Q Ll c4r'-C 7k 1 I.Q tw pNMEMMM Il o %.Well Constractionp�awtf DUPMEM �c�ass nze List aFlnppticablewelD canstntctiorspetmtts(ie.iJ,(tn t:omttRSYate;Ymfaurca<etc� $. � j ia. �sy{W{�e�3F IIss(cit{e�ck��etl m'e): ./7 p #f. fin. ttAli6{ _ ictFaiR'ablFO ¢ ft: im E3eottte171tat(Heeting/CooFiagSnPP13r) dentie'�WeferSaPP1Y��T�) � � �, dgStriaVCmmmeroFal DResidmiWWatatSepply(sb=Q g�tafJT _ anon Fsrnvc xo s �snaom�r own Went N'oa•WaberSupp(p Well: � €r. / - �! Aquiferlte �Gb3tmdwamrRmnediatiaa � � ltgutferstt:ragaandRacovtxp �SabniLyBmzicr j' To, Agttifor Test �StarmwaterDramage iL tl: lei uhnaNd Teftoingy �fSnbsidettet<Cm�ml fr. (hothetmal(Closed Lmop) 1ITiacer 21L L€l!:aifsch�ddtttonaIsT�is fieoHtmmdl eadWCoo]ingRet� Other exFiaiuuader lRemadss) xam►2 To Dascsssgox cotcr snitfioek eta _ a d.Dabe Weit(s)Com3gew-.(a �o`'GgeIIID 5 en ri &C FBCWtYlOwA9[ISam6 FzcdityD�(d:appiFcabie) $• ffr , ,. . el um t+hysFealAddtess,CSt.=amp ffi ft. i h, ZI.8t3bfA1388 rarm.(is�iy 6b.LatFt:zdsaat2langFlatIa is dsgnerslmiaufeslseeaDds urdecimaidegrees: (if weIIBeld onal2inmgisUffi nt) � xjq 6-I8(are)titeweil(s) ent' or[Temporary SismatumafcadiSedwoucoubutor Hera 7.i8 thisarepait•teFa>j 89318�8�lamS 7 herPbJt'caT�ytF<art8e�lsV n�[���nrrted hta+ranTmlce e�&tin�We]It � �lqp svtthlSrAAV=0ZC.01QoorIsAxCACO2CMWwatiCQLvucfra►t&=ft*=ddwa Zl�rhTszapair jtttoutl¢�mvnwettcv�u�euaiaaiaformattohanaawar ftPor�eofthe CoFJ'4i sRwardhasbeecpronidedrathesvaltmvnm: pabvartsa derd3l remarksseetFonarontkebccS vfthsfbrm, B.BidrCon3tz '6e,tgrpbel#3PTt,rQose& flll�diagtt3mara:7dfia�Iwelldel�s: Lyw ctI LWP C,eothenmd Welkhwbg Stesome p um the back of INA page to pmvide additioml welt site details orwell on<on�iGW,tisaeeded.IadieamTDTALNMiBERofweUs Eonstrttotioadela Ytsnmay'doaa ch addiftzdpam. fneomacy. dritied• 1 �J9MIR't`I,T tN4TRIIC�'toNs A0',LmWwelldepthbelowlandso m( 266 Rur AR Wens: Submit ibis fbrm wbhin 30 d aP Farmulttpkwetlst(staIIdepltisif�erentf®ale- 003 ttOg � oomPletionofweIl q Cansttachtonio' thefoIlowiag , 10.3taiicEsatertevelbelo►Piopofmsingr S� {f!.) DlvlsionofWsierResoa:+cea,?nfotmtatlonPrncessingQnit; Ij'.vaterteveitsabovaasmg.ase j�-�� • . 1619Ma3tSeiviceCelt�rtRelelgb,NC?.fi®�I6i'! fI.Eore$ole dta bar: ` (in) 24b.mot_M2l og Webs:!>'tt'additiva tm above,a1sQ submit one oo $te fbrta to the ecldress is 2da It Weileonstractionnmao@: f'CYJ SPY Of fbsm wbhin 30.dW of empietion of wan CtA-a V4MtMY.Wbh6dedPMXetaJ FOR WAMOUNLYwE(eIn9(m y: 16 I3ivietnnofWaearHeso ,tTna +onnflhdeetloat�o,mn ip,�g , z3s.Yleld(SPm) Metttodaf Pest: 29e.7Ebr Water s3r,nty ark: mo,� Ia add'iiioa tQ sending the form to 13b:Dlsinfec0on typt:: � � the sddcew(es) above;• aissi sabmk one copy of this Am WA&30 dep of Of wheieCaDstiu m out to rite wooly heatth department of the comuy Fa=GW.-1 Na �Cn&aaIIq+e�tmeutag8mdmnumntelQoatiry-AF+dataao£WetetRcsoisees Rtvb dZ2L2016