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HomeMy WebLinkAboutGW1-2021-03592_Well Construction - GW1_20210823 82M22-7241 p'z Feb 1519 05:43p ClealwaterWall DrlNing •- WEL,L Mc't'RITCTION 1tEC0 {tGW�l i ar 1sMgmnt Use nty: Itntmhrrt ibrtnTttlop !► ft. StJclt Crnuraidtx>`tame `®1 g 1 37 NC p Well Camtanor Cauftelfon Number' R� �' �a w �ttut t:nmpnmrNemc �} ( It. ��'� r4EAL"rE7t��t sa► z.1Ve8 t onatrttoltnn Pelmh#: �C ` .®� E� IL Us'rdt Opp/1-hk wall amstnroflon panaf s(l a.!Ar„(onrrty,.Sfeft,144HIM'e,etr_J 3 W611 tric(cheek wdl use)_ 7 a� WeterSrrppyr Wct1: T'o Mttmia lPubi'tc 1t, fli in. AgriaTlatral � () QerTcltersrTat(IieatingfCotditlgSupply) �Reside:tTtiol Water Supply(minSic) .. W tndusltioNContmercial 13R4dcrWMIWaterAttpply(sheered) UT p Non-Writer Snppiv v►e11: ry+ f4 h1omtori»g ReotrveTY Inatx on Weill n• Aquifer liedrTttge E3(irrntndwntcr RsTltt:di3titTn 1 1rS1. AquMT Storage mTd Recoven, rf33Stdiniry Barrie _. TM M Aquifer Tcc( QSZtlttTrwatt T Draipag� Subaidenen Content • L"xperimental Tcdmnlogy ��o^-��,r. � Gcothertnal(Closed Loop) t..TCU- 2(k CieMl(rrtnaf iitAtsn li ltc�atn►)�� Qtber(ex in undettfl 1 Remarks} If M .s _s..l_.6L' --Well Intl ^__— i _. A."Art: Wi(6)CntteplettR4: — \ Et_ UVL IV.Well Lttcxtlnn: �}2p' ft. i i€ e ob% (L T FaeilihdOnmcrttatnc Faei�ityf4aii(iftgtplinaMef �4.f � � ;�,,�r Pb(Ysi�mtl Address,City,and 71P r C� 0011ray PaceoltdoodfieotianNo.(PIN) - {tJ�� i�rl`t�� 5b.Lqt W&nod tonpiitadeindcgi'ers NgTmteslsetnndsordecimnl drgrna% T (ii woll fir1Q,one tsMaagia stdlieicnt} � t a�+Ct+rNRr�wtinn: ��, �� g' ;:imnolurc nrtkttTfideVellCm:trneter A-1a(ttre)the weti(s) Rermamert or DTemporary rtm(ann,l Rrrrhvav,tlfj,erne tl e'pti dl(x}rrgr 1SrorxJ wn»,ucvni!n acmrdmnr !fu atlrrtutg 7.inlhisarepuirtnanexifrtipgwcil: �Xcs oc �Ne rn:rl�iSA:�'a4A?.l..RlDOnrtSA,YC.ACO2C.',f1X70R'edlCruaJrnctimr3►Mx>ardrmt +emu yrhlr i�is ik nalr..jirt n a cil vd dl.mv,arncrfE)Ya narfnuandrsplm7,rh.+,.ann,-?fd n 4'r1'n/ildANrarl hnRSN!Qi pfa►d 'riMtlu w+'�I rnvnm. r,amir raider tell rmmala sacrtan arrm tin:loci:0019 jean. 2,L Site diattron or*tiditiond via dWIb' tali site dbtails ca well tray trso f1w bnttt.Orlhispttg�T IS provide addillWtsl R.Far GeoprobelilPT or ClMd-t np Gedbornmt Vl O'having the snmc GyAgtnwAiW drlaiis. You May aim attilchsiddifonnl pa8es t amenw. o msmictim.tmly 1 OW-1 is heeded. lhdieaio TOTAL NUMBER of wcils -• �rrawarrt•AY LP,`CI'Rtl('Ti'(t)NS 9,r1ftt'Weil tkptb below land sutbheC:,r._._ _I 1 trot All.ti1►e1i: 9ttM t+Thhin 90 days of completion of well IarmnlNglr,wellxlisralidapgttiftJjBervrnr(examAt¢-I(�1Jp0'artd ln87 01n9l aiaTita(befd1t3ft: 111-Stntie water level blow top of coming: —[ } 1)tvimit►n of�YAta Renttlrt�s.lnibrottdltrtt 1'noetxs 1JTdt, *"'Ater teen!is nPnva rmtrrs t(� 1617 MtA Sol Yiec Ceatel}iZttdQb.AIC 2 f6y9"ifil? Ii.Rorchotcdlsmettr L (in.) 2tta> s■„�..,..!Sr�'� b&"tioo to rending the form to dw addtnat in TAn k at>eve,oLw submit one copy of this forin within 30 days df compledcm Of Wdl 1z.wet,cnnetnWAGnmethod: ay aructianro the fallowirc (ic.mgm.to Mm.cable,6trmsb etc eui , .) C.ontrall Program. _ — 11'lvlston of t>tister Retlurtroes.Uttdltgltumnd tTt¢eetian tbit WATER fiLPi7 V WELLfi ONLY: �()� ) - t fr36 iTRATt tgerolae Ccater,RAfS06 AiC 2709.1636 McHtttd of teat ` 1 x4C 1 r er In uddltltttt in surtding Iht Owns io 13R.Yirldligpm) of the (tddt4s.5(es) above, also stebmiL ome copy of this fbtm vAft 30 days wmptatlon of even cocotmation ts•the:certutty health etepMenent of the roomy 1.1A.l)tsinfeetiort type: Amount, whore cwmtraeted, I - - i tteviaed 2 22-;tot 6 1+nrmGW-t NartLGhrxrNrmDcPerlmontnflSn�Irrimm�rtaTQuatit!rv-1)lvism7tbf'WararRaeonreaa i