GW1--04835_Well Construction - GW1_20230728

1
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Feb 151905:43p Clearwater Well Drilling 82$.622 7244 p•t
-N2-1 _. ______ ON RECU1_;GW Ij Far1ntcmnl use Only:
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1- CutitrnetOf foXmalton: i -- ---
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t17ctLConteanixafttmt
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. Well 1f � ort:aufica!Gan ,�`i[ �' f1 LINER my. ogri +�. ,
t'1� �� r ) ` J irn)u :t 2r: "
cr iF i_II tL t + in.t
ml►nn.Y'Nnma
2O2.3 - o O©9 2. `�' � . OR •r :,�tnoit
z,Weil Commutation Pertnit#:
i isi rill a�tlfavlils•wallcnasrttrclloH p lmlrr(!.0 ma C.asir{y,4Yg1r;YaNir»+tt ,J V D. i"' . . '�
3.11se)t Me Welt well me): -
Wafer Supply Webs L,1a
i AgrictikAlrai EIMimlaipnUlhibllc 0 & TM" srrr+tat= Taut ssn _ a++t at.
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I.ClunUttrmalafeeiag7Conli Supphrj eaidemiatWmorsuppiy(sIngte) r-""""_"1k. • it, to.
III IndusttiallCommerchd Residomfal Water Supply(shawl) 8. yr , - • I'"
113iMcmlan le L T r t�1 .eta
Non Wnt;r Supply Welb - • - ....1fl" 7� as c e l l v�f �]�.I
i Moulton QReamnvy ft. ft.
IL tr.
*Aquifer ltecbalge Ele7roimdwator Remedratiun I,.. , e RA•: Is- L r_....i-
1i Agoifcr STOW and Recovery fl5n1it1ity Burke NA111101.11 a * i 711,1411 f -`) ,J.,:t. I
*AquittrTest .13StmtawatotDrtingo r-- �' o.
9R Experimental Teduinlony DSubsitteneo coauot O- ft. .
i'(icuthtalaal(Clad Loofa raT[nccr .4 1' '+LOCI ; ,-, - • .....
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i CieothermalOniatin*fCoolin Benin) fj0ttaegessi loin undorli2l Remarksl tt, oz ���1!'�r L'.`
4.pate WOO)Cm4tpintod:Ul-1 Well ION I b r it CO00 a' PAD .I, i .!r- •-...---.—
As.Well 14ombms _ON ft D fL aft i L 1
Eve1'OACi k1 an n O - * tr• . �S't i t1 �' , I '' _
1'•'kiln,.:tiltYJi eTt Ilene • Fadlity Of(ifdllpitagWe) i B' , .I . . ..
'.142D_CAu(- is br(tor tci • .
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Vbvsind A+�rtroae,City,Alld?ip J4-iL 2 2 n
t]�o.�+1 (uf 11 OOM �Y... n-1(S LU
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Camay Parcel tde:tifimttai No.(14N) i
Infemaaan Prr4 g lira
f+b.l 4titoda and Ionptttldeindt grocer tesJsemndsordcctmni degrees; • - i.r„ ,f,,.X,;
(ewe)!field,one tut angs anifletrnt) C coition:
;tea (-F ?1Q1 „ 32 ' 38 14-S w c .l (0 --Iq -Z3
6.Ia(are)the welt(t)#�(@Permautnt or �11.01I111t1rarY S#priatiuoartkntirialVVcllCatmator Data
7 1p grog fh&c-rdra,IheRArceofy Rug the&t(a}ii 004eatrinteradInaeenrdartr
:•It this A esparto ancxiltiag}vc]1: )Yet or 11No rtrki3,t1GCACO :Ai00nrISAIIC.AC8,7CdM00WenCwttf+t.rrimr9018dm&mei ActAr
treb ,"rciwir.,(INourlaww►welbdoaanulan4 Um. _ -airthe nano veibu 4�p9oflhittetnrdht?rkenptnt' lntheWelloxne.
repair Wet I2I reInathrsxtla armada:Make mIsfomt.
23.Slta Omani oredditlonot sell deotlls:
8.iiorGenpttt6MDPTorawed-UupGealbcrmRlWeliNotingtheseme You tray"a°she beck oTthi'sp taprAvideeddbionMwaeitsitedm.ltsm well
consinICtimt,on1y I OWl is needed them TOTAL NUMBER of wails
c+�tl4truelian Mails. Yon also tdtttch side' I pages if axesaarr
dullal:.,_.—
()RlN1'ATAi.tiSY4t ltttf,T( 11ts
ok ratwt watt tfly o trakm.trend masher M V - Ohl Teak for/►a Melee Surma Oslo Oem within o days or completion or well
Reimport weilrlisnrvaoluP'aiffirmu(erampnt-41.17(P,naVial entottUrlianto the filltmisg:
10.Etudes/ow level Wow top ofacing: _ (it) DlvidoaofWAtsrRslanrces.bibrmaton Freeness Uidt,
I.1 tcre4Lmel hobos:tnrins tee"(•�" I' 161711I.&Onke Center,liiltelgb.NCM99-1i614
I1.Boreboledlatoeter: . v din.) yatt.Vorltduc1il i Ina= to addition to neadino the:bap b to uddraes In 24n
*ova,Otto anima one copyof this Rein wlihin 30 days of completion of Walt
12.Wett construction method: rptat g ainsttnetintetathcfoiinwialr
tic.ode;may.cable,erect pub,ete.)
llivietott of Water lRtmttroes,tlnd'ctrground 1 radon Control Peooram.
FOR WATER SEP1tVW 1.3ON1LY: 0 it 11;36 ItfoRSerolceCenter,tGtdgaINC27b 4636
13a.Yiltd(gyp»1) Mad eke IV 7 .iJy Wancr_suyQlY pn �watU In Igoe�tewtatag Ms kw m
- qthe nddre s(es) abate,Otto submit.ono copy of this fbnn oddtln 3o days OF
t Th.INsinrccttan type: Ainotait: complation of wall coretrmctiou to the county depnpment of the cowry
whore coisneeted.
1'ann YiW.t Werth aledin tpesselment at'lien+ireunumnaQnuibu.Dttirnnaf Wsur ttaianteaa Ravtad2,224111 h