GW1-2021-07652_Well Construction - GW1_20211214

g'EI.L CONSTRUCTION REOO, V ( 1) For Ia�raal Use On>y: ��
I.Well Contractor Iaformatton:
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Water Supply WeO: :117. �,•:.,.
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4.Date Wells)Computed: I L.L -LI Well DNt R ft
Sa.Well Location:
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8.For GeoprokopT or Clewed-Loop Geothermal Webs Y u�diagram or additional well details:
cottahrrctic®,Daly 1(IDDV•]is•neaded. Tndicdbe TOTAL NUMBER athe a ( 'See Ova'in Y Use theback of this page to provide additional wall construes ingo
dulled Boxy You may also attach additional pages ifnxosmry.
•IMITAI.DMUCTIONS 4.Total well depth below Lad aarfice: y-•2 0 '
For aadtlple wear Lst oQ deprlrr praffam(tea-3@2W mrd 2 Submit this GW-1 within 30 days of well completion per the foltowiog:
10.Static weber level 6dow top of easing:— �Q 24a.( r Webs:: Original for m to I)ivisim of'water Resources (DWR
Ijunrer feed is oboNs ambr�Ana +- ) lnformFoatioa Unit 1617 MSC,Rai )'
11.Borehole diameter: �• / 27699.1617
{in.) 24b.Foi•Infection Wam COPY to iDWR,Iin
Program,1636 MSC,Rai Ci'A NC 27699-1636 deMmund hrjeetm Coatroi(IUC)
12.Well consftwdon method: ..
(ia+ugsr,roeiy,able daectpuslt, 24c.For Water So and O a- Geothermal tte;rn '�
:. cormty envaoumenta- «• �tY R W Copy to the
7WATERS1PPLY W$r:r c ONLY:?. ===-
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type: —I �
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Qaa1nY-Division of Water Rasoraoes a�:�a<<IA,.