GW1-2022-06993_Well Construction - GW1_20220725

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NVELL CONSTRUCTION REC01W ((ANI-J) For hitellial Use()rik
I.Well Clivill'!w1m.Ilitill twitioll:
14.WATER ZONES
j M TO 1ASCRIPTION
2 It e-
REC _5 ;)"i-e I
Cft
N( %VcII ouoaci„i 1,:tjitjj,ct
11A 2 5; 2022 Lj5.011 Ell CASINO(for multi-rased Ivells)OR LINER(if applicablc)
c I MAI 10 j DIANIIIII.Ii I 1,11ICKNESS Nmll luu.
%U*710 It.
it.
Company Nam,
INNER CASING Of?"HIRINGIBING
i " �l it
2.Well Construction Permit#1: FROM ro m,vt1lorlm THICKNESS %I.%I I IT I Tj
L'!i&"oph d,ic ."11 L'plq";I I "),;1;0 Uh. SIX"I Ic,I it. u.
D Un-
3.Well Use(check i%cll use):
Walersuppl.v Well: 17.SCREEIN
1:110.11 to DI VNIIA la( -LI.L)I s Iz r fIIICKNI-.SS
QUlcollicl ma I(I Icatille,C,,I tiln!Supply) DResiticlin:11 Wilicl.Supply(Silu —
gle) It. Pit.
DIRCSILICIllidl W�11CI'SUPPIV ISIMICLI) 18.GROUT
1Rl"illn❑
FROM 1`0
ft.
PU12 if:11 Well:
ft,
%(Ikii cl Rcclml,,I.
Flioll— I ro LwTI V 1-0EN I Nil:I'll(PI)
D.Subsidviicc Control
B_;""o l iwinia l f(:j­� e J L,op, R,-rracci j
slceiq if neressai-A)
2 ..... I'llIDILiCRLCQ,t1-crila1(I IC:Iti110,00IinL ReIutI I 6thci Nyplaii milet!J1 R,m;!!!�
,,I ft. ft.
_' 2-L womm, -� '�?
4.Date W'elljs) ft
S:j.%Nell 1,,,valjort: ft.
_�J
VA-T
It.
ft.
C,
05J
tl
�21RNIAIZKS
P!­ hr tih, PIN
illitude nod longitude it, tit,decimal degrees:
2
Certification:
6 N W
I..Is(are)the\%ell(sIoTerillanvill (it ''Temporary
7.Is this it r(.p;jij.(fi;111 cki,jiljj:%,oil: E3YV., or MZ No A 1..iX(A( 02t o;W)... ;5,1,V(_'JC0A .......
23.Site diagrain or additional%sell dclaik:
For Geoprobe;,I)PY fit'Closed-Loop Geothel-111:11"AcIls it coos'the sallle You way USC the tMCI,Ol'thiS JMUC ill 1)ro,ldc Ld,hliolial I:,tall,of t­!�
L'011struction."Jil.k i OA-, I,no.xivd, Illdwalc IM;\1 NIIlMHLR_oi wells construction details. You inav Am,atu"Al additioli'll piigc:,it ­x:-
drilled:
SUBMETTM,INSTRUCTIONS
1) Total Nseil depth hvioNN 11111d Nurfiavv:
24a. For All Wells: SLItill1i, thls lbim mzhm 30 da),.; of coniplclion of tveli
C011NMIC11011 IT,tilt:1,011mvill.-,
111.StfiliC VVIlf0t [cVVJ lJL'J01% Toll Ili DiViSilill Ill RVSOLJFM. IDIOrIM10011 Unit.
1017 Mail S'vr,1cv Cvolvr.RakA,_-h."K.-
Ol" '41). For lidection Wells: tit addit,on to sCmilll�the 10..-�
abo%c. also zlibrilil me U01w"I dil, fl'mr i0 dav, -!I i�
12.Well Construction Illelliod: C�_ runsinlcuon Io tIjC;"llo"Vilill
Dix isioll fit'xNaler Resources,It'indurf_,ruund Injection Control Program.
WT FOR AT SU11111 Y wFl-l's 0,NI N 1636 Mail Service Center.Raleigh,NC 27699-1636
13j.Yield tgpin) Medlod of lest 24C. For Water Supph.& Injection Welk: Ili acidition to the 1',,rni ti,
The addrcsskci above. :its(, uhillit 11!'c cop'; M ]Ili, !''Iln %v-!!I1r. .'if, 1;1\,
Ll3b-DiNinfectiol,I%pk.: tkilloulit: collIpictioll of well coll"ti-lic'.1oll to 111Q 11CIIIIII
Where Colistrucled.
Polio i;\V-I im"T"! w"I'll 01,11hi,-D1\1­w"!%\awl I".-mc," R,.,,ci 2-22-IO i