GW1--00052_Well Construction - GW1_20231218

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WELL CON TIL C'1'XO B • :. : I PrirltFarm
:1:.Well Coil
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"tratdorltilbrtnafton . . : .
L►temel llrse Only:. �� ,
David8®Ichee •
Woll;aantiaaert me :. WATERZON®•. .
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-• . :-. NCWellt ntr etosCettHIrationNom6er • , •• - .: "
u••Drli ".... :• • • • .
comp.erN.e�e . .. . . . O � ( 9B n MINTER. __ -
: on�:cu�re.�a tr : 5a. xl�naNeRt nvaa rare oc I2.%-• 9A7)�YGL
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.48,0gpp1441awrlle if•illa n•�erml•PsR,4 UIC.Ctm+nsSlate.Varlau e elegy•• 1:. &.P." - .
3:Well IIre cteckwell use)::'.: • -ff.:
WaterSLPP Y' ell::' •
:l1 ABtl°u>tural. ".�� . ', •�blda-. . r . _teaoM�saR ax►_� � nsAassr�,, lrsox� Tx[eroraea.. .twA'rssuAt,
7B( Ot>► mel(Reatlng/Coolm I .
-h liRl4: & '', W teiSupPIY( t®). . ; .R , ` �" -- to;':
. : .:, '•��G LiduatsiaUCosnmenoiet � -
EiligtlenHel Watersupply(shateii) -
.:: " ■feel_i-"bon • . :.- � ._ ,_ :: .:._ .
Non.Watei'Bappl,� ....• m • Mansur. .®nrLAcsMsntrmen=agnnsosnvr
��Recovery '� � �p� hl�y4 y6i/e....:
uifer •Recharge : :. •::tic dwatarRamedlaiinn • • •- -
" $ $eandRecoyc y $ fA8A1lID/NRAV$LPA (tfaDu4loilble)
*', .� t.�� •'... .. :•. : FROM-- '[O � •- -MAiaANL, .- - -
81uli4v
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.. "._ 8totmwater . . ..
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Caaece�: :
Qeothe;nm!(Closed Loop)•. . • "
. Coo Retain_. i�Other =,:,.,Wnundorff21:•A -Zr ass 110 x�ei(atta�addmonTlwtrem Mw
ate Weil( Cen>pletrds
Well IDk -•__�_..�; ' •M,:Et. 5 ;(t. • :
m4e�anai
:.Si+.Welllvocatbne ' • • • �P
Fpcility/OwoetNeme . •.. . FIICIIID'� 0 liCOb � "ft.. .!L -�• 'I� •�a�� _
F��� Tnpri5 /iI Mr Jti�rri, (� ft.
• : :::' •- •i•Sila...L:„.LLLL's .uy,aaa�tp • ••Aeacl T
" at N r. � . m� 1.!RRtiAK6. , 1 .•
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- Sh,••Iatifade:nd bagitside to degreediy tti/deeonde or ded0Nl degreeys•:• . . • .. • Li-?••"�¢ •
-• pftveU field,one Will ytis O.itale0 ....•
N Re) .r^ LJ
-wl
6:�s(nre)the well(e Permanent •oe Tc a sriFr,Cc(� i P l?.?15 .son.....
2 :"
nW rary bmataraofCmiiHed WellConteaetcr.
• Date. _.
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7.Ir thl.a aPr• • a. '• - ••. . ' : •• sled, _ fowl had; dial the well(s)was consbvehd in accords•ufe
.gyp exl fang• „ - „8es or: o . �'s. tbta
l+O mOlah Mzdrspfafn lbenaiiii gfthe •• ++pY l�i1'4*i1h�`beenop i tded�ff vall Dwur ell Co
(were).
nst,votioa 8tmtdmdsaad Ilrata ..
repalrmtderD2!- rlasedlonprmifbebiukterhlsfirm, .
sate • -• •• • • •®
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�. tkag.no.oe addittonel well tkes.11017'or Qo.ed-Loop aeothenmw!Weka hadhig the same You may use the ba.ctc of$ds to pmvlde additional well sib devils cr well .
eanianetion,only 101►1 kneaded. lndleato TO AL NUMBER oFwelfe. im. else .yh_gdditionelpages ifnec try
. . oonshuc on details•'•You • 'drilled. •
depthbelowlaad.nelaco,_ ) " • .
Foref$1.ftwell.Ns.apdepth i difirent(?riaree-.1@,20D'aad2Q100', • ) -ger-- t thie• . •folm within30 ila3ro of'e°,. .ehoa of Well
ik����,ewatcrleQel6elawtopogeeeinge � � � ��• ,• ,•. .
$uotar' eiv adwa heir,Hse eP . (gt) •c , Dlvl.lon of Water Repo aigei itson Paocasslag unit,
Servteo Cep>11.Hore4tola.dip�eQee: t'e ••'.. . " ..
>16Y7Mail s NC--: •--' .
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• �) PAU Taal ackati iW t e• la addition;to sending the form to the•addles®•la 24a - -
1g.Well e. - s r.. .: , . . . . ebovq,.elso submit cee.copy of this:forin whliht 30-days of coatpletion:of well•
(i o.eakeiretem9•sable,dtteetewN 000 eo...- ..• to the lblloWing' . •
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�deti
1i?Ult WATERBG)1'PL9l WEY.LSOl�L9l. � - .. , � -
lon ef�i►atepRe>so �• - " ' • " .
>ati36 2 t)'. �I 27�9.1 Sys,
13e:Yteld(gptn)••,•15.._ ��MObtlid olftea_• . i .h•4 7%Phe. -2�e.Ray Water au .&tlectlata:VV : :ln addition to.**ding
13>,.DisinBtcflon types�171a4°fa - • the addle es( ) abode,•also.submit one c
Altoona I. oP3►of this feint:within 3h• f
mp . an well conettuatlon to t(he county heaith•degattment.et the county. .
where.c.caetts,ated. .
. • .Parm(fW:l