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HomeMy WebLinkAboutGW1-2023-01057_Well Construction - GW1_20230125 Feb 1619 06:43p Cisaiwater Well Drilitng 82M22 i24i t P.1 WELL , E 9 991i'ION RECORD Lqw.1) Fnr intemni UseOnly: 1. ICAIRxtfarin at• tVtifl.'mEoxtort�t�r P1mM 7r0 D ?ICIAfgtCeo4agori�tttf�ali«►N�mi6er S RCA9ING M 7 w, Cempmy i+tmm� �1� n 3 C� � If '�', ` lei V 2.Well Comtroetion lermit#:, �? _ ?�1' INNKR ZKG D ids►atlop�j�,ttaeUaxirtrt�rianpan�Ji([�;ll[GCarWj,Smv�Yminnr�etzJ 6. [b ; ic. 3-Wdi 1Gc(ctkek adI on): WetcrSspi$WeQ: ? a 1►grlCuipirat Wt�O�{1GiIPallt� 0 R p. �• GoatlraeW(HeRh POKOtag sirP*) &RtwWwasl waw supply(slnec) d Le tnduattiaftConaaar8iai Itesi,teluial WaterSopplp(shttrat) titi Inion z4my • i�4►o-1tiAllr3uppig{Ytdl: it. (� �. MoE►itoring Recovery a. i LROdjHW W IL ! hnt�c '�Oroimdwetctitcmcdiatiun fA9,E[VOX.'llAYQ4PACN ragc and Rcatt �Stiom+wsberDralaac n 9L l Tioitaofog). �5ubidenec tJororol IL(posed Loop) DTcaaot io tjR1iRearm) ' ander#2)Rcmn ts) Fan m A.!late Wdi a •1 t - �a IL 3Z c�cn+apteted. well tn� 31 , t .Si..wail lcteaannn NIo��GtX� `<e t�;�;� rs n 3 tt: � 4 1.1 C' 381 rt 1'ao�1}:tlxnert�atae . Faelt�yit)il(ifapplicalde) R. t6 :`,'i..®;Gf.,a _a� � . Plr�eal Anmae,L'ih4 and zip I k SL JAN y —.�..._..C 3„r acu Pam ei[ewiftcalionNo.(PIN} '' .in�oEfi"�<u»'_1?rye}sa.0 -r+b.l.Atitude and IwWkW a in degreedwirmtexhimRdsordcelml degreLt: (ir�vdl fTe�d.ana ratltong is aulEioicn�) P c don: 6-h(are)tdeweli(Sta�ttaUM or 13Tempnrarr ! si Oeert}kwtvVcllCantraotor pqa roc I, %-rn rats,i is u 41,aiJmms W*.fibm./hadkv cWO J&i me W(Aj ant(W&O Cartotrtcfad It aeoa d my 1dilr�sn p rtoansldfflogl►dh ,Oves or M146 ra7b131+ .K'0 .4/09nrl3A-% ACO7C..MWWd[CQW;wtnngaxdv&.dA, r.�alr Alt RdautkxnKnw�l.aoncv+a�cthmi�jrisuottaa��u`nrrplasnlhexmm -rib rl[murter ravxar+kssaartrptarort[[rGAa�oJfhfaJbrn. , &�nr �-�+�1P'ma or eddilhn>alvpeilide�dter G'oPro�e/pP F os t]ae eEl-Lu►p GeotMeraoal We16t having the sane 1'ou mqy user the Uuck of this page tb provide additioaai well Abe datbb or w X cMtn(cdan,.00lvIGW-I ISIlmdaL.hAmgQMTAL NUMBER nfwclls toastn>Iwddaifs. Youta8YaloMfechaddibmtpM=Ifmccgmiy. dn'iiul: a�'oatvrcll— - �(1D1fr11'1'1'wI�-�gtE�c-r�o�t �• dep1A11R1oNr1atldaWfitce• ��� rrr � Far nurdtplewatlehtral�daptlnlJcBjjerrstlYergiapM 31Za111Q arms p[or►y '1 24r. 1�or aN eft: 9uf h this tUmt w3itan 30 days of eompldioo or wit - cansltaction to Me fellowhs: 10.SMtk NAler iLyel 1tt±taty rep Of a991a$: 1/xaterlarttllsitJwracwsing iue^.» lft} DivJsina of WiterRewu> „frifl►rEsntl� I i.Nonehote+6rENemer: i 1617 flM Jesvlee On, ! .NC2W-i617 13±aidE uhov�subttii!erne in+uidiuoA to�ttdhtg the foCdl W ft edd,nss in TAa aallsfrMeflaptllefhodt �,n e, copyef this form wtlfiht 30 days of wNpladon of well cunstmMion to the foiiotriag: FM WATCIt SE'rmv WxLL9 ON6T: Division of Water Resmlraes.lJ>tl�erlrOttad iq�tt tba Copts)Psogram� np IG3S 1Nmit Servine Ce� ,11RRtciay.rlCZ7b99-ttb3G 13q•Yield(gpm} b R4etl:ntl at test: l� 2+(�8or yMefer Spnaty&Fitt.on'Wetl� In addidao to sanding the Perm to 13b.DkInfeetWA type: Aatauyt: rite nddtesKcs) aaavt� also submit eke capp Of[his ft" wWb 30 days of eampkam of%vatl consttucrwo tD the comllp hoelth depntpt"of fhn mot, ' where constetatad,. ........................... l�fl GW.I Notch C�nrolirmDoparimantoFtEnvtrititlhaofnl Itp- , 4� AfvFwanofWatarRceaa�cec RevFeed222-laid