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HomeMy WebLinkAboutGW1-2022-08172_Well Construction - GW1_20220518 828.622-7241 I-ob 151906;43p �,IeatwaiorWBl4)�riltlni) _.^.---- ,•.�T-arnnl2 (tG'W 1'M. -•!�mr lntctnni Use nty; WELD ,L�o ,=ucT� t.W ntrattor brormatto tVc11 f:mtbauix Namr; ...... � MC Writ CennagorC"rMitn Nrmiber �r a Ihlt� M V►I a I-e—�P u1 e fL �_! -- ol+i T 14 , 111. i ttn ar.t "A CnmiinnyTrmm� jilt To VA a.lYRll Goettrnottoni P,erifilt#: -,,,... "'�", �• ln. ... i.lrraflnplrlimhfo,rellrnnerntarketlwRRlrslf.At/ll:CmrR+Y,Siala,YaNnnc4,rfr,.) ,r.ft in_ tt. 3.Will 111C(check wril nisi:)_ —----- i ,sC N It: tam u u Wittak-SHOPIyUkIR. Agricultural �Mitnl°fpollPubNe i;1 cicotnattnat(iieetin@/Gooting Supply} Reaidentinl WatCr Supply'{cingtc} rt- Indusuial/C.ntnmerctal Residc►uirtl Water Supply OharPO "g UT w Norawhitr Supply Writ: ;r^ h. - Manilt+rin Reeovaty _ Aqulfn Reel►r $¢ �(IraundwntcrltcmediatRm .,n SIN VRL ikC - UqO,,,tj,,crStgrrygr mAR;gcDvcrq 1�5Ninityi3unier 9tROtt 1 3mmtwater DratnngG fr_ rimental Tgalinolopt+ �ISubaidcnct eantrnthermai iCina°d l ne+p} �ITiacPAtcnnnt Naetin aolinR Re>emi) mex xpinin undQrft21Y ftcrn_at'cs) to ft -- e.1►rrf�welt{a)C imapl�teti:3 2 ZZ wet mu,_-,,,.._,...— — Su,WellUtremHn r �� •aciikty[DN( iTPli,gbir.) _ 1�:iailihs(IumetNnmr. •� if'�W�� R. � f{�a'''.,�:^"��•— •-•- _� Phv,l ul Addreax,Ch and Zip /tR 4 ..---- — ` (;cunt ^ knrce(tt(1fcNipn No.(P[N) — �-- �,r,r� r w.-- Fl,,t.ntitudo nutl 1nmRYtudr.in dep(tr tfmintrte5►seconds orderimal drgrnes: - --- ,; „ (iitvpitfictd,nnalnNianuinaut>�aicnt) 0 i �� t,•�, ,et' Uicnfinn: [ �- ,,��,,// •;:ti,itdm+c or(knlF�l9/dlContmamr 6.In(we)Hit well(s) l'mnnneat or CITef VIIII'ov M � Iry vigning 11118 i+,rn,,l hr•M by uuMJl+Act lfia r,rcf/ r,rrr err)nritrat S1OhvJ!n-0eoonlancr. Vex or I�J�►n wins 1,3A wC'Af.'07.C-I111►1J nr MA.YCAC'071:'AM We11CO tttmctim�S1m darda mvl+hat�t. i.Inflitsftrepair•toanexioliogWell" i�_� t,>lty,+ftJrtsr+!rnn1Aoe7�►81tpmlgd ((ofv!fort!rMtrr. !,+'lhle•ixo rymir„All m,rknnwn well amviniclfew iri/a+mallan d Praia the nnwre or'+hn r,:,plrpnferh2j*jV=dyLrjfdn fir nRtAl:Datltnflhfv,(nme. ;.Lrm .tran,orfld4monatiw&,dMNA: this pagu to vide dlikal dM* R.For G etmrobe/APTor Carped-t oni,Geothermal gl►OW%ibitving the snore 1n�ytruc iPtltr(ails it ic�YblrmaY AIm fi to h addldn onel pines if lir mmy.ila or Wei atn.41matinn,only I GW 1 it:steeded. 1'ndinwa TO'PA1-NUMBER pf-r-Ile �.7rat�twcitdcptb pci(Hy land aNrAisa: �� ( } �,>R. a�Q!l lift submit thfa f'orrn within 3t}day'of c(imptetlon of tivclt p'nr•esnllipfe x•rU,v liar nli d eprhe trdl,(ramw{era!np/n-3(..24mond s(1it JDR'I construct{nll 10 the follDWM9: 16.t31OtteNaterlf:velkJAW top Df(ng:sin _ - -- -- (tr.} nisii(GA71Vb,RSirvic nterlAl+ai Bk1,1VCai7894 7�niy 1l'snrcrfmrllsirhmecrnlnJt,Free^,"I, _ O {In.) ?Ah.f(01m sSS�R�� p�.s farm sanding 3d ays Of cOMPIM(m Of WWII tin,*`t+nletlfameter:�._.. fttr4YR Mao 5uiflnit ana ropy . l2 1Pt±6 conttnieeort lnntfind; ,— ------ °tittstcncdon to the fallowing; (i�,auger,mmra•,caRrk,piroct inieb,tyc, _ ) Alvislnn nfll~atct'RrarwJrcts.Undai'grnund IPJmtlOn CuIttral Progiram, t1()XRWATERBCpt�i.V WEi.LRRl)iVIY: jrMMaRtSte,•vlceCenim-,RiiteiskNCv0*9-1016 1A.Yirtd(fii►Al) )Nt!titnd of test: _- __ :Ztc 1�'nr PJa Wr CnnMv ls tipie°tl n'we O In uddMen to sandlug the form to !lie oddlr45*5) abritre, also euhmir an4 copy of this form widtin 30 day,of Disinfection t Amn,mt: camplation of veil coo6huction to the crpmty health department of the county —_ type: where conneactnd, 14mn CW-I North C.wlinn MwImmil.ar i,wlrtntrim ni 0judily-nivisrnn ot'Warar tkmJources il+tuletxl 4 Zblll