GW1-2022-00990_Well Construction - GW1_20220107

828�622-72M P,1
F ob 1.5 19 05;43p (;iealvual(ae Weil Drlltln!11 ,.,�•'•^
W�:1C.+C4�iSTRFTC ION It�[;OR� OW^� ):nr lntcatnt t)se nty� --- .._
• 1.ves>s,r:�nn•nerer•lnli►rtnallon; ....-----_._--- ..____=.:�._ _...__......--
1.
- R C IN. rar 4
w:Writ CnmmNnrCntifiewonmrini r DVC
Centpnn�N�mn i..^.6 (--........
—
���:!,1Yr11 rotnstrnrttlnn
00 1711(iml((whrc rcQJ(CMtgntrrinrl jllertttirr(l u,r/!G,CmrMy,Srrn�Vm is"/r°•crr..j'--..rr -.-- -- in. -^
3.1Vc11 the(check wti)live).
AAdc,dh(ral ImiaipAl/Pttb{14 (? ft.
1114
CTctxllm'ntati(;anthtxJC;nnnttR9ut►piy) a.•gldarlUntWatcrSupplu(c{nt;ic) "'"�'•ir -'-*f• '� -
U1Anxtriall('.ntmnrrcinl
Rasidcntint Waller Supply(shared) g 0117'. s
Nnn lYstfcr5sspplyVRrll:
Matiftorlas MRtxttvety tf, fr-
q.
Aquils'Rrr:hptgr. �(IrovndwntcrRrsncrtiatinn >fQ, ,1
nc�ti fir StarpRc Arid Recnvcry Sniinity l�ntrirr Ps:oatt rf,
Aquifu7cri Stnnnwni5rht t g' -- -- --
Lxperinlemnt Terhnnlav 1331lbsirienre control
Crenthrsmal(C)oecd I.nrslt) �l'rnrer It'll
Clemticn„Ar ftHaatin ii�R R.aam��l)ttiar(ax 1p uin uf)+tar117.1 (1rmssrks)_ T rr, rr. �
t-Rim Wdi(,)rmmptnted:1,-�1 L�Well
_ --- --
Off'-
( 11 C, .-...
sv w"ln
ft
I.trility(fartcT Mo fanlity It3f'!�-G`•�ipPl�irahlr.)
,P sIrn1 A drcFy,Cii�,� A dil
r:amnp JL/' Viliml I tcntificatinn No,iPIN) — _.-_- -,.+— -^-1
Sb,',nKtndc nrnt Mnglntdt in deltm lmistnens/,aeronds Or drellnAl ---
(r,veU frrht,nn fitAnn in at,fp(•I©1 p r :12.l;ert) Afrnn:
ti.to{xrc)the well(s) tx mnne»t or �frrmtnornry l ltr ere n(G rtlfitft We11 C'optrnater f)Ma
1: .Hpnm1,•(Atc_;nnn, /A»r Ar ukdlta)wrc Anrmv)rrnteontmil ps Arum-ft e
%.i rA,isarrprrlrtonncxixrtngwcft: i(r.� nc Nn w•N�LS.t•4?Ar't12f. llrlrlr►rf.fA,YC,rcnn.',f►2f+DIr'rfr(.'rmrJrnrrin+r'irnmr4no mill rhnrri
17/Idr;,r:rr. ir.. Ilnvtknm,mn•• p tnpppjtlrterrrnntha hem pm►K�4wmMt.-wchnwrrr.
rlt.hMafq,dJn,l 11+jae'MBliDa/Ale fdn++n•IN+IUY�rtPhlf
r••NKrlr Hndr•r f,21'-Nnarh U014tt fit(pith!hhl•fi njlld���arru. )��S�ftinlita*ao nrO id dolt WIN01111I111t
R.Gnr 0vopra6tfli PT or t lrrsert 1.nr+p Celstherrnal Weite haVink Ilic vnnir 1'nn n►ny a plr.Iniak of 111h pligi;(o praVlde Xdd{liomll lve11 silo dtilnilt or wrtq
,xmstnu:tinn,only I GW4 is nrcded, litclicato TOTAL NUMBER rtf"vrlls cr,ati9ui+etion�trtnils. You may also ofth wdllltian"I PRI,l rimembly.
ririllrtl:_, titiMIICfll}136`
`' Ir^rot Nei t►nlnwinngsurfaea;,,,� �'. 5 (IF.) 7,0t, �'nr,t)t!t VAM; 5ttbmit thia f0a"'Otilin 3p pp�•s of Complydan of styli
h::r nr iffir 1-vt fir orhWepau!f,,irTrrm,r(:r"nrphs d("1f9tPnnd.0 fr1114Ir{rntlgrl tU IIIC(0iI01Cing;
i Q Rintic watrr Ievgl hatar top nr¢n Ill M2 T_ ,Uo {[t) Rlviaina o(11liatar Re mimit,in amilNen Prneseraft UIi11,
(Jeru,rliwc(fY,vtnnncpcM�vet l6ITM■iRser ke+Ctfdtttr,JbIdRh,MCz74P11-107
t i.RtrrrtmitdiutNatrr c_ � ,-.__,(In.) Mli.Ttr rw►crrion WAII 2 In Additicin to mnd9na the Horns to gte ndArom in RAn
t?. ntt thud: _ n►`nvr.ate'submit onr-copy of°thin farm tvllhln 30 days of ronlplellotr of Weft
\VrMi r+►nrtrnGtinR
rflontmetinn to lhr•fnliorAnir
rr c.nunr.^,rohf)•,eertrM,ltirn:tptlsl6elc.► --_.---- -T•.•••-�.-
tVlR tNATI R t+t;Pt►1,1 WEt,r.�t gWI.X: �- �_ _ -...._._ ._.�_ i)1Vlsiptl OfAlikur Rtdnums.Undergtrornd Ir(Jeetbn COMM)Pnerom,
1�V/t um Mfi
t 3a_Yirld(Rpm)^ ® _ vMh»rl of test: r�l N.Ir., nr 11ral,r Sun etF&TaroaHA(k Wer o: In u14111169 t/a Snild111g Pub f M in
nddrrss(cs) nhnvo, also ssthmit nne rnpy of INS: ifhan within 30 days nr
(ib.01sinrernan type; AtDDrrnf: r:nnnptctlon At .veil cnn.%fxuc ion to Ilia comity bcAlb Itepnnrnr,IN Of tile CnudfY
-- -,•-"'..'—".--,-.._-�"` - -- %vhnre uals-41tnr1M,
i:nrn,�:q,.r NophCnmlHin nmm�nrnfi+, i r
fh't+ n�+atnmrnmirr;w;illsy-prnlsun ofWAfe Rnnrlarfea RrvheA2��.Zi11R