GW1-2021-06876_Well Construction - GW1_20210429

Feb 1619 06A3p GlearwetterWeU Drilling 82$-622-7241 PA
WB�rI,C IIC7'IQN RECORD(GVI+it Far lntemai Use aty;
1. di C,nntraetor Inlbrtrtatlon: ����
CJ %T\ -
-- � ,
WellCond�cta Nelpa o01
�oR' c
Me well Co,�tractmcetrNimiiom 1�A,mbe R �
Vem To
Cnmp+my Name
2.WON ComarnolionPatmito. n :aA a
f lit all ANdiMbld wall rx»muumlanpam Ar(l a INC Conw.tam Yarranca,air.) Ef Et in.
3.lVdtl file(thedt wco Ime3c
Water Sappy VPe": 17.
Asriculturel rmiaipollPubBe () Ee, �. hw
Otmttcrmtal(Iitlating(cooling 3upplq) Rmidemial Water Supply(single)
rnduslrid/emnmminj Residential Water Supply(shtrad) a ifT
Imi ion J,a
T►nrt Water!iuppty VI'ells t+ 1L
rA
Recovery fa fo.
loeltt�ctorAgo Imd RcCovay �Salatity 13tlrrrer VIL
Leq"I Tedwfty 13Subssidenac Conlml lit.al(Closed Leap) m(am Lql:i Nb ra
a. h
A,Mee Wdl(n)C:maptetRd; Well IDN
Sa. 01 L :11nn te. h
�c1� bon a -QcLAk� ' R. IL -
I atilii3;7tut,et a Fmlfty ON(ifmpplicame) !ti
Physilad Addrasm,L•tty and 7,rp
KS
C,a„ry Parml rdoaiitfeafitm Na(i+hPq
r+t►.I.atittide and loni tad a in degreesimimm estsecondsar decimal degrees:
(ii'won rckl,y.gft Wkmg in soirteimt) V 9 =' e Bnn:
IS.Is(stm)the welt(g)�PermaImnt or Oreml►orary Simfaalwe at ow Well onttt,arar Gate
l?v mint"f1m.oarm,'r hrndiv awry+Mat the,wa 4 xar[waraJ eau-dw In—r,*--
7.in thlu n rt:pair to an exisdox welk Dye$ or mo wal,IS .W-A C Or.0100 or 15A NCAC.01C•.000 Wdl Cmxrmrrian AftA rtb mat Am jr
;rrid..icnrc2nolr.J111auAmonaafi.cars"wfavhomeNonc�N=Pfoi6dw.anm%ofow zoA7vfddtrrrw1ARt'7mpnotd&dlnrk wdl r#Aff.
rr,,mrrNAT f21 auprukcacsrJ41►wow drtmckafftfam,.
2'I:tam dbrgetmt or sddltlwtnl fvaU OMINik
8.rerCeoprobtAaapTor Clmed-Leap Geothermal Wells having the same 11ou may use ll►e bath of this page to provide addiYiml wdl Abe demo or well
°ntttunctian,only i GW i it deeded. i'ndinato TOTAL NUMBER orur-lis cmt91mwbn ddtailR. You my also awb addiommt p ws if omelleary.
drilled;
., COO w><•
S Em l �,u�'>Tonls
h TeW"4ndQP1k below land surfacct (�) 241a, F Ai�►el lLlhtrtit this form-tvilhin 30 dip of coneplcUon of well
JareanrNpfewrdel:warierNJnifdm6rrtar(uanpk 3�?tlGd'annt{611 consmianto the f$lordw
rn.&atlt wainr keel below top of easing: --- (Et) Divisioa a(Wotw Rdnm em',Iafnrmadom Procea ft Utdi,
{rward,rantIsownreamrns lie^.- 16171 lxllService Cater,RalelIId.NC;z% 4-tri17
i r.iloltetroltdiJlelettr: (in.) 2ft For aIy tiQU Wdlx L)ad don ro s -ft the tbnn to the:adil mm in?Aa
12 Well cnllttrpCfln)D rrtet@od: J�� 'd`'1{ shore,sho Submit one copy of this lbrm Within 30*V of ao watfoae or wdl
G c.mW,-Wy,mbk,OiM pofi,ctc,) �T cns►slmtYittn to the folTaviitg
@iviam of Water R mum
es.Undtttgmud Ittj(eetlon Canttul Program,
H101t WATRR St'M V W)ELLS ONLY: 1 rJ6 maa Sn vlee Ces mn'Raloh�i.xc"09-1636
13m.YRid(1Pm1 N~of tear. Tat For W kr su r&hrmtlom*d In addafan to warding ft than to
13h.DtsirrF the MMMSR(es) abovq try submit oa14 copy of this form Within 30 days of
eetion ,Amount- comptalton of well cc► mwdm to the enmity health dtpam mu of the munty
wltata cMltitrrrYbd.
I+nnm Gw-I Worm amlhm Dapanmom of tinvtrtim=bd 01canly.JNNamn ewater PAmar as Rmfim62-22-201 b