HomeMy WebLinkAboutGW1-2023-01381_Well Construction - GW1_20230208 VaLL
C RUM.�...ri.r For loWmd Use Ott i
1.wa8 CoMtrs�r tm:
We1�1t'7aorName
- q Ulm
e i Oo n'
t►,
` 1�lieitt3or�courCettifi�tiotsNum6er i
Ism To
q P061,
07
3.welt Lbu�rncttola Penmdt>9:
�lsraugpp a61F r1tconahs► foal td(�. rub cmo%Eat FM*m,.aa, ft n. ;fir,
s.walu�tcbactcwen�): a. �, j�.
water an:
w YO 1?L5&�$ ELOi' I1YA
a Ar, tn. 1
O(WnWCcof8 Sww tt. m.
Ccanmaaroial �al avatar$u E .
1Vonwafipr 8npp$►Wells Ft. tt, R �
R ft. fL
s
" ReCbarge �Ck011X1�18tert�cmediatian i9 LIL
n
Skmp and Reco m l3Saliai sugar 'PA
To
AquifraTbltSttWatesrDninaga 0. R
1'fealmotogy
f3eot cmw{hosed Iaap) CITmer
tlealhetapal Rearm Udtdr aaadar#21 R� To
Ga
a.na%Wt W coloplateds —/0Jl wen mN a �.
on.welt Loom'. lon lt." -'A.
--�w� Imes ft ft. �.
FIUrrName 8coitityiZAlt(ifapp}ictbta)
�� It M
Cm* PttCet Id tlmrMo`.(PIIt) r ;
> tet�tle0n�i or$eE$tlal degreeu
a2.Cm�eaftola; f
. N W
CIS(m)the waNdFamuw or DTemparary alb t:w""�'1Zf►e Coate �,-.-..'"`....�
s
jtp av
7.IttLie a g8th�apn%1104,rarer lat*VdIN m uftw d(R ooeorrkaia%<:::.
tgalr to an uMgg*I&- Oyu or gwo wA IN NGC 02C.01M or JSAIWAC oIIC.0IM OW Coam xft S1otldarair ad>�t
lythtruarrpttr,fflowimrrnwdlmawicdoboanp ml+YorthismvmdAahem►panvkdea*wgowm r.
rwatrtmderdfll r.-ma*.T=aorr or an thehacF:aJY lrjZo,=,
ptDlrl'or C,daod,Loep Oeoziiermol�eQt �$ite dlagrAm ar nddEdonmlwell. �;„a;:,:.
L Far Qea b tag the same` You
eonstsnados elm back
Yarn flats�6 i addlt wd web alto det&or wait:=' r.
e c*1 QW 1 mmadA InBicste TlDTAL NUM8M ofweita may ,also mach WMcnid pagm Xn=w=y.
dtiliad: T
�,,
9.1w wdt depth below land wrftcas ��'�0 ..�._._{f�) BarAtR-M-.�-- Submit this a4a. & t� -
l�rmru(akwd�r�irourdrprb:y'dlrtex�c�2oo�ondT�lon9 ---� � vAthhi\3a deYa of amqledoa of alelt
-
eansl oom to the"Dwir gc
10.8tatlews►tp level batow tap of eatlnp: 2-1) ..�._..__.._([�) Dlvhdoa of WSWRe�oraa,IrfiarseAgon IIett,
{/xmrsr hest#abovacotn+�,vat IR-7 lllaa&alrYtes tCenrsRele ,1VC 396991 fiT -
11.Bea aledUtalatet: (L) 24L Mw TOWN WIAF Ia addidanjta Naft the h m to the after in 34a
12.�Ne8coaapaatlon alathadsAir above,also ad=4 mro oopy of ttdstomr wtthfa 30 days oi'omnptetimr of"a
(Lt.UUMM4q,abk dkeat ptutr,eta) eanattaction totha gawk*
DtvMan of water t a �t,Undagw+Oaad Ir�adtoa comal ftwau%
FORw�lTilL8tJP1sI,YwEid:B ONLYs WOW
NC Z70,9.1 f36
Mdhadoltaek 24C,For WAJM qV <dftftk In addition to amdbg the fbrm to
the adftus(es)'above, also submit;ooie,copy of this'fbcm wift 3a&p of
II3&+:�Eis98€��t'lmao sae: A�aa�>:e � � o construction to IIie�eaamsy'�'> ens�,f fbe¢muay
'_ d