GW1-2022-03363_Well Construction - GW1_20220314

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WELL CONSTRUCTION RECORD (GW-1) Fur Internal USe Only:
1.Well Contractor Inforninflon:
14.WA rE R ZON-S raml I too OF.'C'HIPILIN
38 7G'A 4 L C16L.�f
V'Not cl I C Certifica I too,NLt;llhCr
lls)f)�LINER jil'apRlicable
15.OUI I,
to
&-d ill To
in.
Company Nanw
16.1 l`I*N ER CASING OR T In hermal closed-loop)
2. I Well Construction Permit#: USACE-FUDS Site I:R()Nf
7,Wapp Cmmil'S"wc,VIrWMIII k)
3.Well se(check w ell use): in.
Well: 17,SCREFN'
L 2"cr Supp',", i FROM I FO I DIAMIAER I SLOT SIM I'MCkNLS,
QM Ell]161)il IITLI 111 IC
Geodicillial filvatintz,Cooling Supply) []Rviderifial\Vai,:i Supply'single)
ft. 1
IndustriaKommercial E3Residential Water SLII%pl) (shared i
18.CROrr
Irrigation FROM _(1
Non-Water Suppl) Well: ft,
OMollitorill'! OKc.co%erN f.
A/
7
Injection
Neil: & ft. cvvc ref e
Recharge [36roundwatei Rernediation 0
19.SANDIGRAVEA,PAC licable)
DAIJUIlCr Storage and Rccovcm Dsalillitv Barnet, (if p
pit2m TO m"!F ill%L Voo(l'I'VIVII.N.111.11101)
DA,jijiferTent Oslonmoatez Dralnat_,c
DExpermicilial Technology [3.Subsidence(',,it[;oI ft. ft.
DGeollicrinal(Closed Loop) 20.DRILLING LOG(attach additional sheets if necessary)
FI(m 1 It)
_jGeuthcrmal(I lcatin,;Cociline Relum) DiOther icxplalil under';21 Remark,)
4.Date N\ell(s)ComfolviLd:2/14/2022 %\cimo ---------------------
v
131 ft- K, C-'Iii�t 5AX,
(Z 2 .0
( aL5a.WvlI Location:
q ft. to. 'ye
4 /3 10 Ile W,, I ft. I Q 1 A
2 E Z- e) 6 I it. i ft,
21.REMARKS
51).Latitude and longitude in clegrees,rainutes/seconds or decimal degrees:
fi'la, I I.,,;it)
22.Cert c•t
. : /I /
-Z Li 7 N
6.Is(are)the wvll(s)�IlcrnvancnI or 01'emporar) Si name�-1 CL'Ilf"'d Well G,mraclol
.........
7.Is this a repair to all existing well: Dves or ONo W V 1( 0'1 6" ", /�.j 1( 02(
it,i
"7 4 ,,Ag,
23.Site diagram or udditional well details:
N.For GeoprobeINTor Closed-Loop Geothermal Wells having[lic ime
Ymi may uIc the hack ofthi,,page for well Site tl"?t1"S(to weltConstruction,only 1 G\V-1 i,needed. Indicate TOTAI NtA1Bl.R_,ll wClls con,in.ci'on details, You may also attach additional page,if necessary.
drilled SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: _(it-) 24a. For All Wells: Submit On, torm \otthin 30 da\, of complenon of well
ph, 'di'lepm,dzifl, ol ?:,
:+,Ilqluclioli to the fioll"ovirl'-':
10,Static i%ater level below top of casing: O (ft.) Division of lik ater Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh.V:27699-1611
11.Borehole diameter: (ill.) 241). For Injection Nell : in addition it,sending the limn to the adiross in 24a
above,ako�Ilhlllll one copy oflhn 111mi wiihm Y'days of compt;tlion of ooell
12,Well construction juvillod: SO-4/,- CO!1.1111,101011 it,the i1ollowinu
o,.cmgm dm!opu,h, t:
Division of NVater Resources,Underground Injection Control Program,
FOR WATER S1,TPLYNN El,[,S()NI.N 1636 Mail Service Cvnier.Raleigh,N('27699-1636
13u.Yield(gpm) Method of fvoit: 24c. For Wafer Supply& Injection Wells: In addit...it to iending,the lowin to
the addre,sfcs) above. ako mjbinii one copy of thi, gone within 3,0 d:i.\s of
131).Disinfection type: Amount: comploli'm ul wCH L;onstrilcivin it, the county health department of the county
"hele C..11,11 t1cled,
at,q, ......