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HomeMy WebLinkAboutGW1-2021-01893_Well Construction - GW1_20210429 Feb 1619 45f43p Clearwater Well Drilling 828.622-7241 P.1 �„CTIOAf RECO (GW >i1. ®� ® Fnr)nta/fnlUse nty: 1•We11 Contrarlor infortfpdioa: V� one 9 Doti t Wen Conmor Marne t ' S a Imam I TO. a��°, .VC WellCnmraamCatffitalinn fanmea, &Id V• Oil I�nthrmeNksO R ; Cnmpimy Name Pe x- �D � ��1Q5 `) a f� 1YeN Cot>raf�toa rttfitlt: � m rux � a Jdrt a(J air�npiwhia wall amrufrmloJrpann>xr(J.r^(Na Cm W A4ata Yartanre -j"" f6 k &Wrll the(ekelt wcn ufie)_ a. Ik in Water Sappt�r N►tn. 17. A cuhllirol �NfoniaipRUPuhitc Q 11. fra fl. itr, 1 1(lientlawconiing Bftpply) �Resideeltlal WawSupl ly(single) w, 1. SIM lndusidaYrAnmerchl itesidtafttet Water Supply(shatwxt) lai ion ur - 1Voe H rater S v{1e1L Man Rem ft. 06 ` to Aqutferiteelf�e DGrarndwaterRemediallun n. R AgWfkrStgrW lmd ftMcr.j DStdinity Bfurier 1 AquiferTest ftD1p n. n. i:)cpc Mental Tecil logy •[)Subildencc Control 1L R. Geothentral(closed u4p) D7'caetx (lettthentfal(Ntutin 1' ) Older in nndor#21 Remarks n. M 4.hate wol(s)C nfltpleted, ��6e11 1DN l /t. R. ricitity.YA4nrrNmno . Fao7i4[Dt7(ifapplfceldc)ff f n. � . DAi E R 1G Iysical Address,City,and 7 p�� ft. Yr. Caunfy PAteel rdomiftmfitm No.(P" %4.latitade road 1onRltudeindeg eedmin~secondsordecimaldegrees: 6ewelt ra:a,one belerntiasn4ta10t) r 22, tins: 03Y ti.1e{arc)tine wa4t(xj Pmrmmm or t".f"-" prw!y site oF(>.ttiliod d t_aatraeror t]s1e i.la ihia A xcpnirto aq cfaUd Welk aJ1t+r�R+ .AM r kNVAY aa"*AN'Air x�W4 ores M�1 Coeur DW►AV aernrA*mr ova$ or wdgr 15AA['OX.AiOD nr tSR 1YCAC O?C..O?(lO itr,�f C+nesrrtoo SMaMnhn6 mat rga►.r hldaixnr�palr./11/mabmwnwaBaar�wnulonattonmularpJafu/6r.rxrruneofrlo �RV�JMrtrsdXr/h4c�AECplplt�dgdA'i/hpWirllnxOkr. rryrra uadrr ezl rmsnrkx xzYltm mraa t(e:!last oflNrc,ratnr, 1.L Site dtatlnram or adedo wl windMtil� R.For GerrpralwAWror Clotted••iI Geothermal Welis having the stone You may use The bwk of this page to p ovidn adr ilml*A Me dwaih or well ►nnslnuxian,ooh 1 OW-1 is needed. Yntlaato TOTAL NUMBER or-Ols ufnshwa lilxt dewts. You Ill RIO Nub tiddldmlal ma if limxatery. driliad ___ ��O jrj1Nl7�ih`Et7'Rtt['iTON6 9.troall well deAlA below land sul7plces f�l 26, Or 41.3Mla: SUM*this form within 310 days o1 tw plain of well f%nr dnNl,ple wrJtcfis+eftdrprJ�a Jfe�tJ6rxr(erastplu-3(nll0�d'ont3 a�JfTO J c*nqmiollta1befdIowft: 10,t er rt.c water Ie c ft ogre tap od taslrrl — -__(tE) Division o('11 ow Ramses,Aaibrmation Aroma Ufdt. lf�mtr,fa.xlJraMvaaaJrrarte G 1617MAServieeCeatfrt',1tiHtgkNC"09-1617 11,1tonehotediatfletpt; 0 (in.) N W lls: 15)adMiao tD?rtb.�,�„�1 tfending the form to dies atldrotef in?An 12.WON ellmstroeffox all ll; �_ ,Q 4bWa,abo Submit me oopy Of this form wigdn 30 4ays of emoadon of well (i e-*NP,[WY.MbI Orm poll,e(c.} IX at�tmt tch the falfowint FOR WATER Ct'itpf V WR1.LS ONLY! DtNsiort of Weser RtargJrerR,UadIroaaA tt4tslMn Cog"Fra�reaar a A 1G36 MAIN Service Cea mr.Ratetglt,MC�!1.1636 13a.1'fetd Of tar: _ 2�tc Qor Weser Ratultfr rye iaieotl�p WNft IR addt'tJatl tin:ifaldblg 111E t5ttn In 13A.nteinewtion type. the eldQttsS(es) adovq also S9wdc ono'copy of tW form VAVdn 30 days OF AaeotmC eDmptotion of well owauntedon♦o the county#=am depmmu a of the campy whom wanurcolA I+non ,CUy-1 Narth(3eatinaAapnnnontOfttnvtrrin=PAQmfily-Divisionce iWwRaJamim AtraiaeA2-22-2e16 d I: