HomeMy WebLinkAboutGW1-2022-10601_Well Construction - GW1_20221122 li •
s of .
1.Wep Coutraeetor InnMilent
ftald. to
Woll�efnfa•la►Mauro ••
212e-A zv ss
Newell Comfeutor CoAil�altaaNaffar•t =
Conned Brothers Well DdWng, inc.
Can�ntt y N1ma U ftb rt,
3.Well Coagrtte8oa Pertrdt A =lfty
Do am qw�ma Writ a►nojWtoff u pwm snot ,MGM eke
3.Well the(ahaak tre11 tttt►jt & MATERIAL
e.
upp t
ABiluuhuml • ' Munfot�fUl'tiblla .eft. ►3�� " � ,d/2 � U U
Qoalhal(enni•Imt11110001itt8Sopply) BR*Mmftl
Weterllmp*(fin o) thtw
UComtneretel DAafldatttial Wales Supply(ahatet!)
aM Aterporit-e ...t �. o n' ab ft' e/4
M --
AquliMrAeoherSelorRenmediatlfm R. —
Agulkr Stomp and Aoopvory,? =� (Wily�atriar
Aquihr'Fpt mn��'• r��r?�:?� g;amiw�, p B. 3 tF' �,,
Brfpedmontai 7'eslfewle6Y ubatdettoe Control A. ti
Ili
Clembmmsl(Clow hoop)
waft
4.Date well(,)Cotnptatedr 1 Well IN d Y D F n sf 04e4X
sIa well I.ocettent d 0► i 0 e n. p, 81-� d o-rd
usantty� n•r Mna� .....'.....,` �fni�mfrttrf�nlf�lfl J�o tr. �3 s � G�...K �>:,,.�
53 (o ll,Xf� _�
Mweleal Addmc C14r,and Zip
«i r i rr ririrairrr__,irrrrr
Cawny lhgnoi 1116fftitkstft Na.lpiMt
db,LatlMde And lendlttnfe in dwrfofttNnataf/s if or dttdvial deyraetr
tlrwoli M1J,fine taUlanp i••uil>obe►! ><3.CetHRleutont
o g g
1�(nI�N...Z .�3 3'U .,_ w (A M t 2—
6,Igore)me wen(hDPe ni oent or t3votnpowl
a rwtsrNer
_&,t4��,�,I m*,cw t w Aw trt(IN wo AwO mwnw d In ouafdaaner
71 is this a repair to an enittttn8 rret{r toO�tC.A/OB or tdt ACWL'`,p�a�11MNt C�7�ttitioJla+i&riedai m+d rNai a
(ftRU is p►rgfeIn Jill out Mrotfn 11vft ttnyMtlotf t�fteAtiifr► MAtra rRe donor ofift A'Oft f�frrd IN bmf pnavi W to fllr uVI O%vW —
mprm notW dtf f mAl•eMtm or an the bash O thlofi r. 33.Ste Oloppt or Additional ttWi detoll t
B.For Cooprebemp r or aottl& Cl olhtnr W We 1 the aama You nuy�M the boob or Of pop to ptavldo adflttlonai wall file downs or wall
eettsttuoiian,only i OW-1 If oWAM igdi�te'pD AL MJMVAR arsveiia �►dr�ftl..You euw aho wattati edduional RAoa it tnoaarfy,
driN�t '
9.Total well depth below IAtt9 egtfieat ® ...SIR•) U16 Submit this am within 30 days at completion of wall
Nfrrfefrll�*I%WbIftf►llifor�fVt bra+►haa il►r r�"�""""�" oDinlnfa1 11owitiS
it 81111leWoler level below top ottu ftl -� iR�) old"of Water 110110111,1114 Inforl ll"P1011011111 untle
(/fmterle►rtis&*IVwhtA#v 11•'1 1617 hull NNW Celle,PAN041 C 37OW1 17
11.iloffthe dhtateter1 ,,.r.,....tiu,1 ?Ab.Ti�ro�I� hi eddhimt to WAbs dta Poim 10 to t In ,
'� t�N abom Aw omit ono copy or this tbrm within 30 days or eamptotifm of well
13.Welt vollwutl9it moot.• O f,1.;3, r,..._r.■..e.�arwa...n...Mr nonEltuafion to do fb#m .
tl.a,snMfc,tetoty,ffsbia.dlfeftpftlb�oto) m..
114vlsioneivYttpriheattt'ea►1Jt a ad1 C27614
Fori Wn'i'KN t1uPPLN w8i l tt t>►T1LYt . . 16M Mali RwAft t atstffr�
f3A.Yleid(sptN %D Method of teat l !n oddhian to rea ft the fhmm to
DD �a rho es)ft ; she t on Ow of this tam whbin 30 day or
13b.Aldnketwo b" AutoatNt tmmmplettan or well aomtntetian to ttte oetudy beelth dopenfnant or the oeunyt
witera twttsttootad.
Fofn OW.I ,' Ned CoMilna lkpttdfnnn Of RnahtmMW0 QUllly•0 1010 Of WAmarRsmttftfts Rorl•ed 1.a3�016
i