GW1--04891_Well Construction - GW1_20230728

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Feb 151905:43p CleatwaterW$Il Driliing 82B"822 7244 p.1
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i Contractor Information:: ^
ei_ llnspownel
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Snell towman'Mnrc "°"""'
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-1 fir,. tr.cWelt `"'onme raCealliolfonHunger • gR�(p�
f 1A /� •
t'ymixuspNratty {� Irina OR t_?-' ttaitt
Li tall Camtrwll1c art trait li:J.Dia05,,,....... .„__,.„,�Yato,Ya�arar�dry J irt.
List all opl+1laaAkrtaalfamtrtnrmiatrltarmlts{ltt WC,Cannp9
3 Wcit I1it Oka well use): ft.
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B*Weti: 1 �.►
Water r Su .„p►mt;liyNit atOTaldii vamoose T mmietni..
•Agricultural DMuntelpat1PublIc Q 6 a. ib.
Id r,•i, .t(lieatingiCoollooStgipiy) Rollie: d Water Suppl_r(single) '.,....-•* . tr. W.
11 indueitiallCummeratai Rmidomhnl Water Supply(shared) ` die . I
1 htl taliOn •roWe 1 ° M)-1-•,
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14414411141.SDP* N:
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A ail - QReaovary too rz i
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NI• 'niter Iteeltttf¢e Citienmdwatot Rcmedistinn
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p9SA r • gL[ C..tL ;I.n� I
lli•Pifer&OMR*andRecoverr OStiaity3ntiei
rcsomm_loo
dt Aquifer Tea 13SccnnwaterDral►wg+t ra. re.
l Gperimentat Tcciptoiov •Subsidence Control O. it. .
5I Geothermal(Closed Loop) rinkitcer sit' •' .:.P LOG • • 'I' •. I :i
Ii GeotUermal(Ncafin If._.ingKctum) Atiter eX inondorll21 Rcma:fes) It. te• 'a
4'°art:WWII(a)Cmnplttted19-20 z- wwuin ('oO lk 2 i 1 ff. !� un (�j' • ._
5a.Well•locattinti: Z R , Vl. . .mot
UnLreo Po%5 a. G�
racitkvAlnncrMono . Fad.My OM fsfarTifolik) n` a • I ....
3c0c HuxA 5 _ urnaA I It tk a
Pi ysiml Addroac,City,and rip 1QC I �f
1'1c() ;:„1. _ ., !WS I
C� l/y.N Ili/ -� Parcel tdaauirsuionMANP3 Ii i
Sb.Ltltiludo aoll MU ttgde tnidegracemimutdkserendsordccimal degrees: I trr.'..+�� 'a ,..;? '!:r►
(iuweitfrdd.mu:Womb aattfcnt) s 1 ; . , lion: DW �"(a
qlci Iv
6•latency the welly Permaittat or Drol1►urarg Oetttiiati0Ve11Cattrtwsar Dew
mimes es ac-fur u I sere recess y,tat dr wet*sKm 1vain) /,vU.Sd as ornoMercr
"+.is this a repairto ram witting wclr oYcs or No with i3A:fa to 02C MOD orISA;YC.AC 02C.Wl0 M!f Comae a,srat r Nmr' ha n
ithlxilargtalr..Atloath:wannallratattac an 4tArmmtan�:rl�gala&anao:o((m 111141httMord MOM ptaf IfirkatWAt outer.
malt 23.Sue Boaramors tiotiitwelettel
8.LerGeooprobed/PT or Clone-Loop Geothermal Welts hovingihesmmc Par may.see the bock DrIb ioiro to prowl&additios el well alto detWIh err tYett
ennsbuctian,ontg I Gthf•1 in needed, r to TOTAL NUMBER aUs construction Mae. Win MET also Mach midi' pages ifneeemeq:
dead' _ TAT+IJ
ni Total weir dapgt bylaw land ototdccs f Dc - (4) Via.7or,Qll�Saihe Submit this/tan-within 30 days of complodcrn or welt
Isar maidpla wear littaliatytibtril�lvain krsn4pla at lrau a td ielaa9 i01110tlle lbIltiRikt:
Ili•StDliawaterievat below top otcaatog: (l ) Dtvitton of Water Rnourees.falbttltti11os Procasfag Volt,
rower runt frobiwr coons Haa I t617Emit#SiinksCentelt RUafg 11(CX7d994ft7
IL itoreholedi dimmer: V i V�1(alt.)) /� p alb.forytjecttostWallm To addition to sending the boo to Me od4tcoa In?An
12.Well mbstn 4 ellan metiatb 1 1 i JJL.. skim oho submit one copy of tb1a fort er11h n c
days Of completton of will
fir.anoccretars.able,eat putty,47o.) roman n asAsttutdielttalhefollt►nrittt
Maw
dergroold
FOR WATER WPM VV LL3 ONLY: 1fi3b) Sa*. CeAtaau•,R4dtdgl,b nR� Program,
13a.Yield(gpmt) 1 ,) ilfell ati argon _QA 9 24e,Rir Wller_Sonatr edjileollomWen: to 'an 1nsvagIvo gm lbmt m
the addniss(cs)stove,also submit one copy of Iihta than will&30 days of
i3b I)Isintbcttaa tnn - ,Annumt: _ 4ymptetion of writ cotntt:egon to the comity health cloonment of the county
mlmtre comontoted.
Rom OW-t Nord:CmcdinnOeRonmontofiimdrdnnumro1Qtadi -fxvistonot*WYQlr&mntear: i itnvUgd2-223016
1

Will Mier SoliArevit Certification
Owner, OLLPS New Wet
00WS
iltereby way that the above referenced well w in appwrancein aaooltancew
ith
all Canty Welt roles.
well Driller: ` P-, eack 0 si�n►ed:
ammo,: Z4( - _ nax, : ab -a-3
Construction: Gmut
Total Derec05 ypeL
Thickness: rn`
Casing Depth: (-0°
Diameter: et g
w
DriveShoe:
GPM \