GW1-2022-10608_Well Construction - GW1_20221122

WELL CONSTRUCTION RECORD GNV-1
For Intonel lJse Only:
I.Well Contractor laf.rsnadon:
--J-9L4k Q ) A��-n �, IA.WATEK FANES
W<Il Contractor Nanx nou rat DEAcalrrmv
R All
Nc( CovvxwCcn:fimnn NunM IS.OUTERCASING for w.ukattd wrlb 0RLlNER f Rhb
`^Y•1� \/ f• �, t- aVnZ P. M TUbriskDIAMLTER TRt[O
Cory.ry verve :I,, 'y Ia,INNERCASINGORTUBING heraal esmrdiu
3.Nell Construction Permll p: PW Sa01�.-10069� FVOM TO DIAMETER TNNKVf39 AIwT[It1At.
Li•I elf al'pllcaD/r utk torounu:on prrnlu n:v.UIC Cmmrr.Stm,.t v,e... ntl A. IL la
1.Well Use(check well use): R. 0-
Water Supply Well: IT.WREFA
INOM TU mAMrrEa SIAT SirY 1R a[45 MATERIAL
❑Agriculatlnl ❑Municipa4AlFlic R 7 n. r� L. � V
❑Gemhermal(Healing/Coohng Supply) *Residenlial Water Supply(single) R R. Ia
❑IthindsixVCBinmercial OReaidealiel Water Supply(sIt") IEC.ROUT
OIIrigmfio9 FIwelis>100IXln(:.f) iT(OM Tm \�.irct a! Eun�..+Cr"#N ar:tr,r,a AVM'•r* .
Kow-W1ler Supply well: M1 Q n. A ryso
❑hlnnilodng C7Aecoctry n. n.
In)eedon Well:
M1❑Aquifer Recharge ❑ m Guntlxsm n.
r P.cs:':u::m
f4 appnrsblrl
GAquiter Storage and Recovery ❑Sniin 1t.SANDIGRAYEL.PACE ily Hamer FROM I TO TNIATTRIA LN%.ACBM[.vT MLTKOn
G.AquifeT Tesl _ ❑Sfoonw'ata Drainayr M M1 1 PkIy
GExperimevul Technology GSubsidmce Control R. M1 x=
CGeorhe(mal(Closed Lawp) GTracn It.DRILLING LAG albcb atlrgdeval sbau lfea
To Dgscwmov tew.buew..u:ara sera
pCaeolhermal(Hearin oolin/.R.etu�mr)���G�Chhm(explain undo all R raQM euutYs) t IL narks)
n. xk C!
d.DO,WeRN)Completed: /V+`�[A +..rrWell 11M / R 73' R ,g
1S. Well Ladd..: nn�� n. n.
Lsy%x .RW{.\Y' W\1 fS REl�
r, ;—/�+•t:. _,a
PoeilirwOwxr Name Facibry lU•IJ.nMlaniel R Y7-:7 s �
L4717 V Q16 A QtIfe Ac UUMtINacioh d/.cl RNov I'll,
Phyafni Adlrera,City.and Tr R
�70Cet[E II.REMAKES
P i T C 1 rat:. ...
Cowry
PArccl ld<mBra:aw No.IPINI
5b.Latitude and longitude iv drgrem'Mvuharxe<onds or decinul degrees! —
Iifwdl field axe bt'l.ne a sumcieml II.Cert(gndov:
/o-lo-;Lz
S:Ymwc rl L<— i:�><racv:�r /atr
6.Is(are)the"i'"W: V ermanent or OTemporary,
Y Y ta^^./MnbrrmTr,Lvd<.rLe:.w/.aael a.wr.rolri:,an.ra,wr nd
!aA A'(:A('a'L AfaAwISA NG(CA:C.A:MM'rtl(:.urrveiaa SarMaM aA.der.:rop:
7.Is thivarepam to ao eabdng wrll: UYn Or O 01h.rcranLira M'WmWMm Yu u,'a axaf/.
//d/r it a rr/Yv,lJl our brow.eG ew:r:,•Iw:4lfarpmicn aM rq•f:n:.:.„uv.frM
,<por uM..Atl rraaa.L+renrrW ae dr Aa a oJuo IwW 17.She diagrom or addni.val Wdl dstaih:
Geothermal W'elb 6evmE d+c mmc You may use the bmi of this page m prwrde additional a tl eonsvunisn iNh
R.For Geoprobt(DPT or CIOxd-LAmp (wld Nee Over io liematlu Box).You may else auah additional{ages if oeressary
consonen m.only I Gw-I is needed. indiure TOTAL NUMBER of well
drilled:_. ---- 7 ya.SUBMITTAL INRRUCTIONS
9.Total well depth below land surface•. IfL) Sound[Ihis GW-I Ithl.30 days of weft rumpled..per the following:
Fw nm(r(ply uelO Grlall ArWbr/d(16rm1(n.�A1J<-)fu.aYl'aed l(gIW1.
1 q 24a. For AD \1 Ax: Ougnmi Lxrn w n:+:.nm of Want Rprmrc<s (OH RI.
lo.Stadc water level below top of eadng:_—. IILI Ldnmwiiw Rucump lnu.IA11 Af 5C.N.hiyh.NC-"euV-161)
1/wra/nrl(r ntuva rmiAy.mr-'"
_��,_Hit. Iqb. Fur Iof \A'ells:L'rpy e+OWN, U.Jwpround Rln live l'wuW IIL'C)
11.Ibreh tlr. )ole dlator Y^ Pn:gnm636 MS,1 MS('.I(ulalRh,NC 2'I694 I06
IL Well wnrtrucdon method: Ya'1�� ���irl Nr,i.r_wa urnwnvu pp�ydO re Lu. iiwtbermtl Return Nelb:Copy,,he
(i<.augp,rewry,wbb.d'verrpwh Bcl county rnvinanullrca •f�nunl of ibr r.wnly+v— erc IfTisU ll c�
FO:IA"l ER SUPMLY\YEWS ONLY: lad.F.r WLet W'Ib mduda user IDd GPI:CoDY to DNR.CCPCUA
1'cnnn n+gmm 161I. C,Re agb AL - 6 -I 11Ilegpm)I1Derivu
form GW-1 Nonh Cmelu�.Iktannvm.i 4rvhmumnml fhelny ❑v.wm:of w'.mr Revaur<er Revved&bath