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HomeMy WebLinkAboutGW1-2022-07241_Well Construction - GW1_20220805 -,G=f.fuftlL w ,L eUNSTRUCTIONM ORS MW f� g uSBv ►: .; `7 I.Wen Confractwinformafirpn1:/l_ j WATHRZONFS Neff ConinactorName PROM - 70 D]lSCR14ftON - p ComparyyNamo • 26.IlVNBBCAS>T�}t}8T®INA r1 2.Well Constcuc6on Peretitdv FROM To I WAMETM I TMCI� A2ATS�gfi List dt appticawwell Construction pemdrs(i4.WC,Comag,star%Vwiance,era) ft. tt in. - 3.WeII IIss(cber$wellnse): ft. [AquftbrBtumvandR=vcry swPlyWelh 1T.s tilivtel 1� star toss nlw�reut cIFa1/Pu1y110 f3 fb ft • im herntat(Heafang/CootiagSupplg) de�ialWaterSupply(single) M. j tw sirleUCommerclai [3Reddeatial Water Sappiy(sbated) �OtIT tlOn FROM TO EaSPLACf£D�iT1�CHOD& OUNf aterSnpplyWail: ltot0 WeII: ferRedWv CIGtoundwatarRoafflatiaa LtbrStumgsandRecovery �Salmitysaaicr rltoxs �a �tacK +rrrrlscsoDfer Test �StcAmvaterDrau:age ft. ft: rimetmal(CIMed lrnop) QlTtacar 20 D LOG attachadditian Aadsemrel eatit>�Ca Retrran Older Iaia smderZ1 Ramada) �or,2 To naseslEngox rotor hnnin miYiotk eta 4.Date Wel1(s)CompYeted: �9'i._?- �' Well ID �� �,.L17 �a - �Cr�o, EacilltYlchmerDfame // FaciliWID90fapplfrmble) th ft.fifilms'. I �DSr _ PhysiaatAddn�s,(Sq,andtip #t: � �> PersxlIdenti$r aaiNo.(PI@ll} i Un Prnceoctng Unk Sh.LaEFtudeearl I Ionglinde in degrees/minnbdsecoads or decimal degmem Dtia Qr ¢Ewa}I Bsld.ase tatnongia suiRaleat} Z2.Ce cation: 3ti. 4931�c - ?q. InSysti - W 6.Is(are)thewell(aQ&06 tmnent• or DTetnporarf CaardedwenCa Data Z Is tills a toga Sy signing rhls farm,I hereby o�g&*arlhm,vegs)ivar(roue?umstrrreted isG=nI Ce repair c sftwell: Dyes or � svitIcI5AAY=02C.olovarr$ANCACO2CMWWaConsltuchm&andardsmrddwa Ifrl+ls7saisparr�lloutlarawnweticvrrsrnuuroninformatIonaruleaplairtthenaaQeoftbe -Pycfddsneamdhashmupwvl ataftwvUmvner. - regatrwrder#31 remarlssedionarantlrebacl:afthFsform. I 23.SitedlegE+amara8d�a�I svelld�7s: '- 8.Far(leopwhefDPT or Qosed-Loop Geothermal Weesbampg thesome You miry use the back of this page to provide additional well site detdb or vdl construction,on>y1GW-fisueeded.TitdicMTOTA1,NUbSERofwells conMC(iondetdIL.Youmayslsoaft&additiodpagesNucc Ssmy. drilled: 3?-d �i��nvc�trcrioivs 9.3btal well depth below Land surbee: .F this form ro All wallse Submit v Win 30 days of completion of well Farm >tt d*L"WSIWaadept rdffff te�aa�le-3@PQ(Im,d2aQiQOry ( , 24b. cansttactioniothefoIlawia 10.StaUtcwatertevalbeiowtopefcasings y� {�.) DlvlsionaYWatcrBeaumses 7atbrmatloaP avicessin Qni lf, level is a6ova owing,vsa"a" 1617 M311Service,Center g :>�t�,NC�7699.16i7 11.Donehote dieme6el: ?Ab. ibtect]oll WeIIst Tn addition to sMft the foam to the address in 24a. nn 12.We4eonstractlonroethod: 1l�n above,also submit one copy',of this form within 30 days of completion of weA G.a anpa;satary.cabl%diret paaTseta) eonstfuCtiontoftloIIawft" FURWAa,'FRSUMY- WimONLY: 7DialetonafWeterHesour ,Tlnaert mtarldeetio,sf:onh+a(Prog�m, . 1�36 Ma���ei�tce t�nber,�a�ghrrc�769A�f�6 M.I'feId(gpm)` �.. Method f}1'teSl: P% 24r-ibr Water t r. I&10i eCtion� Tn addition to sending dm fora►to 13b.Dlsh&dWa T F'I the addresses)above; also1'subna ane copy of this form widen 30 days of type. Amount:-�y l.h• completion of well cbastsuctron in the caaaty health deperlinent of tha� �ereeenstluCted. FamOW i NarttiCe:nTwaDepammataf8ardroamaatal 4 isY-DivlatoaofwamrResonrces RsvisedZ22-20i6