GW1--03450_Well Construction - GW1_20230518

I::o 1619 p6:Q.3p GleetwaterWell Drilling 828.622.7241 p.1
•WEAL MffingicTION l QRR(GW41 Per itRgmni UM n y:
I.W Moira In nai�IM�i . p• '
SVc1Ft9mtragarNpnln �'±ice 1 1rc•'��ar .:,,7T-,�.,,
, • I
I 1�2/ ////�\y 0. ft.
;tic Weil Cnnt►racateatlfiaAltaa Number Fr 0: - —�
111 c :L:L c: .. i,._ .. axe" 1' ,
.Well r+la amlanPermatlll: 'c !�Eir Al...,:.• r i,•I. MAIIIM
tdrio1lltarmie'41 srnicuottintros(a V1O,,raw+5 , xfraa,ere;,.'... _,,,. IL IL Irk
'"
3.Will Mt a. fr. la. I
(�ft�ativd»riser.
Water Sapptyweq: , . , T P'_ I -
.ra.(,• J. r:.Sf_r:u:
i(?tlathcmatlplatiiu$/ConlingSupply) Real terSupply(single) Sr 0. Vt. in. I EMI
A fodusltletlCommemlal MRelidomial Water Supply(Annul) - „:.r,1�T I
$Iiltl:3,ibn :r)umsF f2LyiJ..?r•_ s,..,.a :�w\I. ..,,;,,::i_ _ .,r:.9i
Mmtitori Recovery t+, 6.. 1
*Aquifer
Aquifer Ratline d) ��y� a�Dµ.(tmlmdwpateerruRcmediaftgn p j
*Aquifer Steblo anti Recovery i..I ntt,Bemi+ 'P"4.,. I1. 44' . P. y`a,=i1y•'�. TTl''�;I i �0fLLTtl
II Agefttr'reSt mnn aterDrainage a. a. ^��
9S 1 I:crim anal Tadnio7 �b&k2enee Control -- D. fill i
t ..
S Gaothennnl(Cinaad Loop) DPtacas "".....0 I•r �� .
Irbureerra
M(fanlitr t N01tin a Roane Other'(aupiotn underfl2l ttcxnxrtm '" `�T' '►�'"'�w
4-N14 W01(10 Complete14.21 -023 Well MN - t1M& s 0 aV& I_.1
An.Welll.cteation: . D ft ( 0 -R I�01.-a.NW I - -
-DONA Ki cbocrda.0 - i rtdlll ( N,,,,� . F.dN9s sDN frf�rtiati ) ..,a
r 1 ax,Shall • tt , r f ,
bail Ad dams,s,Chg axd 7Xp / p ft I
„ i. - 4
t:;amy isles[dantitrmllpnNo.(PM) .... „r,..,_..-..-. rcas. _
Fib.WWII nail innatidttndn rreclatlrmtcct9emndsordceimN degrees: L
ONO fir. onebeam faodfieientl tllyrdont
6-Mare)the wett(O Pormailest or r, tl�ure e!•Onttlini IG'antraaEo� I Data' \ �{ J v 1drnio3�- I b youltl I Ow Anr nailfj mu E{r v)tw,sUnQal kt aret s irr
l 7. thba repair toalADftllingnth fly of �UNo Wilt MA rx'acfx.gM4er15AAC.1CNC...V►0 Ina Canl+e ms dGenddma
'1sW .orVaingiimuRnow+ttwJharkvutGtmut�nr mfafmrdapfcenth[.x»arceJ}ho &vo *mor►NmcAtatlprintledMtdcwellololra•.
'mak raider h21minas=lilaorenthahorkt{1'lOtrJbmr. 24.E alarms oradllho et>iRi401110
8.ForGeapreh118pTor Gasedditnp•Geid?u l WdilaUwWingthcsoma Yea fltigrrr8o Ube backM ibtsD LllrOtlideaddit(oitW wall tiWstt Awe or well
cuMhuatinn.only I QW l in nrcded, rndinnin TOTAL NUMBER of vinlle cottttnleifnn flails. YOn my alto itttich nitll3 ili oa igttw pommy,
driltndl,_,.,,..,.,,,_..... _
9 l'dult well depth NM bud Mitdheat LQ 4S- (R) 21r►Far AB%At Sabath this arm within 30 dabs of cam]tlotton of well
irerAeitoptc wile?LW,dletdAtifdrfivem(emmpla.41N/ft'o1111 4 1 1 0 69 winsInuliottiolileildlostiog:
In.Stalin w+alertr vel Wow tap of adage (ft.) Division ofWatar Resourem(affirmation Proemial;Unit,
1/•anan•annitrnlvrraegmet era A"'" 1I 9. }(n?Mel SonteoCeaten IhtiaBBs'N4C27699-1017
IL ttotettoletillintl3el: !2c v (tn,) ►,n�..r.lecrtn. tee to sdd1tian to iattdfng 1 fan in the Minna In?dn
yl / *ow,ow submit ane0:ayethis hors Within 30 days of completlan of well
IzlVallenllett�aiientlmtimd: rn ,lsl.!"+ tonntteetionto the followinor
I".m4F) V• ,dtrantailb,ata,)
Div�lon of Water Rlfttsttata,Vndthlgl+onnd fIrjesf nn Control Pl o rom.
I WATER$LPAt. L9(IA11,Yt 1t'r36 Mall Santee Cemar,Meletatl.WC 27W94 6
c
t3a Ytcfd(tlpm) Ne8imuirteatt 2r1C, i rS� ►(6lttbmG oaa� ta�►tddll(otnnirndtrlgthe to
r���/1 tint ndac*l(ca) nbam, py tb1a nn wilhln 30 d aC
i3A,UlSatiecl(aq typo: Aninunt 1 1 ►eo coq,tafion of well crastsuation in the county Width dnpfAlseal of the enemy
- %draw caralwrted. 1
FormOWN.4 Writ CmnimaDevusmnne.faivhsfemm,wlQuatity.MimsDPWoter Ramon itouiol2- .Sold

Well Driller Self Sr ut Certification
son `✓
Owner: New,Well:
Address: 2(-! b r. ►I
Permit •
xherebY attify that the a referenced well grouted In appearance appearance In acadance with
all County Well rules.
Well 9 'I"'-e. S s`
e ra e : l tom- D Q ed: .
Total Depth: L64--- aerne-A-1-
Caeing : rik.a d
Casing Depth: 0) Depth: at)
Diameter L Q
Haight _
Drive
Oft IZ