Loading...
HomeMy WebLinkAboutGW1-2021-04606_Well Construction - GW1_20210429 eb 1619 ia6,43P G111arwaterWell Drilling 828-822-72�44 PA i .r•►•wr•. Fir lnwnnl Use Univ 1. 1 GtotraeMr lttdbrttWWn: Its trnooe tra 'VCR �(:imu�aaa[Name VC Well CaetraerorCet"011on Nrrml er ii c tw t^orNAVIRINAL t �in. onmAay Name 6. BR t>fR I Well C ° �r► otntroeNea Permit idtt aff M#10 bid well cr ulmak"fl ar(La 1=Ceww,,h'Atls Yarlmrrc,04) EL (G 3.}Yell lice(cbm*wcQ tlst:): a• a` � WaterSapptY WeA: t7. Agricuhgrei anicipaUPttblic A 1t, tL 10• t fro Gttotltcmw(I4cating/Goo Ing Supply} Residentini Water Supply(single) �, % Ie. lndusiddiconnnerestl idcdtlal Water Supply(shared) Uri tier iYtm V1 ales Supply�1 ell: t+ A, MU Monitcrirt Rdaownty tt. fa lnjecHrm el: Aquifer Remltar$e [3as nmdwetarRemedistirm p. R ' Atprifcrstprggb Imd IReenvtgy �Satinitp Barrier � a Aqu1fcrTcq $C1tlttWeriTDrainagc n R' txrm itnmmi Ter3tnp(pgy 'E)Subsidcttcc Conttml t< Gcothtmrlel(Closed Loop) D'Ptxcet l oc (lattktxrlml Haatftr i' Rttula) Othtr in urldar W21 Retnazics � 77 r f D+ro Wdl(x)COtteplt t _a�7' c111DN T� R' ( — +a.Wdttmorttno: M' � � i' bh q net Natnc . Feebly ON(if W11cable) icnI Addroax,Cite,and zip �`^�h/j n xx. Duty Yenel idcntiffmHlm No.([ pNK St►.1.gtltade sad(oogiitude la tfcgtecc/oritprtes/seeondsordccimat drgrtxss; — ONVORfrctd mebtgeeauani9datU it zx. flan: Inforin3D�R Ssct+on 9 n li.NAM)the wdt(a)�P+a maattlt or D7temperwy 8iaoa (tetrlfinl dJ Caatramtmr Otae T lAv arpnrtrH elm.flare,J hepr ,tangy awn the viWAA)ma&=4 cmon W h,&c nfP w 7.le this Arepairtbanexiadagwalb E)Yes or ONo xHIrl3A!;r.K'A2!`.pttlOnrJSANC.AC09C..OTaOWeNC�nerRaaiorr3daau4mt+mrlthoe.r rrirl�ivnrcPalt;nllarubmwttmad.meruxcla�a,v�1+�wwlFarmderp/oinf6e.xrtmrofiho �PYaf�rnsarm'1M�r7M1Ap1nt�ldl/HhesvPl/lav)ler. ""Mir nndcr AU M Mntlrs AWN"arnM tits had afllwfa m. 2 i 3119e 1daReam or rttldldomt wtdl ttaetfla: R.Far CeoprohAWror Cloved-Leap Gedbermal Wells havitag lbea ne Yen may use the back of this page to provide adt t l well Bhp do alb ter well onnatttttxfan,only I GW!it needed fncUma TOTAL 14UMWR ohvclls ctm•4t wion dr ails. You inlay alo afth adtddotlal p>tge6 If ntireseety. driNetl: _ AMI1.1E&MIMMIMI S h Instal we"depth Now land avakcct U .._(R•) 26, Mr AIi alto: Submit I tis Ib!m within 30 d►0ts of complMon of welt I�arnaLlpkwr11.c1:Wartlddppujd/BeMer(eranpla3�1U0`aixli�ilt?r?� conatrnntiantotdc�lotflag; 10,Static tvgtgr 1&41 beks tap of tasinlp (ft:) Division o(WAtar lafbrmadon Pnmewft Unh, lrxvurrrawlltrai+vrecmfffl,Me(•.�-t� Q 161?MtilSlw*eCenter,ANdgkNC�7694-1617 11.llottotwtedietet t+er, �" V (in.) yam, a.tocn�Ma,�x Fo wk8tion to sending the lbrm W die adiraw in?An .wy t "Welt.maw,-R'�tY able,4trret tatsh,ctc,T +Q� aNme,MM Submit M9 copy Of thle brill w199n 30 dens of wmpladen of well li a etloa nmt6ad; t onshuctiortto the follwA tg: RtvMm of Water Rewunwh Uade govilad In i ntiaon Coot Prtlgram, FM WATER St*M YIWELL ONLY: iC3b Moit9ardoeCeattt>,lbteigU.1VC27khf-16i6 1Ja.Yield(O�r) M1dAtru of trstt ` lac,Fpf Water 3o>eatr& iaeHon Wdtt 1t!addidaa to statding 1!!Mtn fi the Wdiasc(cs) nkwty also submiL one Copp of thla fault w8htn 30 dmm of l3h.Hltinfection type; .Aruovmt: comptam of well consttualon to tbc;counts health depanment of the mwtty vrl mrc corwtttreamd. armGW-! MUM lkeothmAapnrtmantofiinVftdnMunralQrmaly.jXtf.grnnm'WarmsRoyonm" Rev 2-22-2016 I!�Gc►Cl Di - r �PdI Ica, ,, 3 4 V