GW1--07290_Well Construction - GW1_20231109

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Fah 1519 05:43p QlaatwaterWell Drilling 82$"622-7241 P•z
'.-�,LL_cON ow oRU how' For Use dnay: .
1- 11 Cnntrartnr I forelotion: ._ ....
S _Il!'�I� I �-
we) t men scot Name .. '•••• •� '"
A t �
NC Well CnmraclwCatIderetwiNuml er .1 CS"/� m
L'ampotryNama `^ t i
2.Well Comttrpdt�Pariah#:, �� I LdU' i ? i�S a- '�°' in _" ft *mud
goNATI:am
NV an°Wh elk walla tmetloupageftx(1,,a.ma Cnw v 0114 frarlirnra eta.) - a- k. i'in.
3.lVdl the tcheeli well aseg to In
1 Au
Vvatcrsoppyrjy�; 7 ilfe elAM 1Rt! attoTiitZtZ1 `gsttcrtetttsa 1nA7iilttiAt.
ApicalrJMunicipellPublle it. flur
v+�n11WnW1l. lltlg(1+'Ot11i(lg ply e9idCgNDl water
511pp1y(Ilfl C) r.n ._. •
ntndtcsitialleottuaeraisl Raidendat Woes-Supply(shared) - I
OiMgiuion — $ rTo A Ike � 11 a ewer ply
n-Wntti•SupplyWelb - ' pcl) a, nn �
Nikloaitoliv QReu.orry ft. tw
McCaw Welt: - R. -
1a'AgaiferRatli a oftmundwatcrRcmadiailun t .
AtlaiferStoweandRecovery DolinityBania `tom iLPA .ra r,�ca�r►'rartrtran
Q}AquiferTest f SttmnweterTelmlBaz n" °' I `
34perimental Tedmolo6}► f Sabsidenea Corot -� a.
aGhoti mat(Closed )) Crow; at)3 IiT0iD 1_t • : :r; " ! f'w.1r 2
1:1. 7 ' 'T ' i + wa}ry
'Geptthecmni(rcatin/Caali moot_Ciflear(explan under 421 icmaks
1•nata u►dl(s)CptteptotRig ---aott llfH `
• t nC��n �n { QS :� ..-__.__
_ cO�.G Grp Oglit. ]oS lb . 6ft. j IRA Sri
5 1. "iljstbnn¢FNstna - n—f �Itsa�mi�EylDd(iftgtpfkALfe) a. a.
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P lam,Addrese,City an 7.fp �' .�•�,t
,.x1.femme I I v l/Y t) 4'/il i It
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Canary Pateel&t�tifteationNo.(Pild) I' �:I..,.. . ,::,t:- •:.. ,> -�t i j,
rrb ii'Rk', "...5.•,.
.L4titda nad OMMtatfe la *gram
Cii;.K1ficTd,ancl6tgoaisattfQitctcnt)� 62
i ��t ^o� xT.Ce oAt
,. IQ -CI -)3
b.1e(ttti+)the nall(s) ermsneot or�Pllemporary Si4na tltetl reAOJe11G�ashtmtm ; I Gala
�T\\ IA;reasd+aPref.I htrfe!vas +s1,m ea�.went j llow,1 a eme fa armrdaver
7.Is lliL a rept;irta ancxillit�weiiC Xas or Pto welt IAA ACO2C-.4100or/SA?WAG Me MOO Weli Cotu/nretttotStainkrAcot0 that.r
frOlsivorgzaf illiaueinemweRonestruruno mnttan attt go:wear r iett 40.11nfr/tGrmorliatlEPAPiai'NttothlsWeilrgsvltr.
nook wirier AZ1 remake YattAn Wen IfoItedo lbfsfffmf. 1.3..6114+ or languid swede*
&ForGeoprabrfDS7br Ct Lonp Geothermal We-Weaving Menem
rttaX.mo the back otitis pip tnlimvidOa4 e)wail damnsew veil
consinictian,aoly I GW+l is needed. 1'ndtcato TOTAL NUMBER ofwclls c+ �►uinitt[r1AiVs. Ybnm ynlaoattaohaadd)ti tpatesifnoaesaall
drilled: ,_.,,,•.d,..,__.,-.— r..,.
APIMEITAWIWINGURNS
I,
St Tateat well
tarMAhlolcw Lfbantf ohtin err le-3f 206randirea"`"s (IL) �rALodi r..> dtlq&tm within days ofcaaiPlatloa of'wall
f ®ensmlctiantothclbllowfag:
111.Sadie waderlcvelbelow top awing: . (-a° (fL) Divisloa of Water Reltiiu421610 bttn oa Prowling Vtdl, .
'I -erref graben tarsbt$roe"•" i ilop, MTMd alnico Dom s[dgb,NCa7699-16e7 _
It,itoaahoiedflitaatt r: l,0 I U (tn.) •
Ztk vori,'oeiiop yvdlee to edema tc seiuuna the!bent 10 the nddraaa in 24o
n)K li—t above,oho submit one copy adds fbnm within 30 days of completion or volt
i�WW1 m►utrttctlala matilhdt ' enosumtiontothcfalknehlg: ``
tie.eve.Mil:able,taregtMb.CIO
1. Envision ofWater ReasAuee.h V delgruand Imam)on£liufr Program.
I()*WATER l t i�A1.x WELLS ONLY: 10361lh11 Setrvkx Ceases;latetghJPiC'27 636
i
134.Yieldtgpaq 11lethodoftes,: 231;Foy Wiley Soynit&ltUiaeBODWe1E:1 la ditfoun to sanding the Sum Iv
the l ss(ce)above,also Submit aae of Ng Ran wtitht 31)days of
Lib.INstareetlnq ty ilroount: completion of well comwction to the comity ikbftuneM of the aanllly
wbora cmwnxrard.
Perm 0W-1 NordiCxorolisaDeparimenLaftowirdnmuttnlQaBlier-Division oPW erlineoutt09 Revis0A2-22•2016

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Won Darr Ss*lihrout Geres***
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Owner: • .R9ccie-ircy4f)Ur,
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Past lit carigyihat the above/defamed well vas grouted in appealuOin • • -with
all Canty Well rule.
well.Diger: ) t ‘ke---Cidtpli°S
Certfficater: DiteGtatted:
Consinsikex Grout
Total Depth 1 OS--
Type:- C6TYM .
altteknesm CY)CliAo
ngDfl
Deptix
Diameter Le
Melt
Drive Shoe: