GW1-2022-03350_Well Construction - GW1_20220314

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to
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to p IL
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In.
x.Well Coarnroetion remit M
,t am„pIdimble Ivey oftTONmion para,ltt(La fltG Cmmq Stara Yarlroxe rrr.) in f l
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5.I t Ric(Chan vidl list): �17 K
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W0111tarSuppiyVell:
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A,griculatral �MmmkfpNUPublie � i(rIL �
iv es{da lial Wator Supply(An&) l
rl [► a
crsctn�l(LicalinglCaoSis►g 13ttpll.) .
tnduslrinilGtmraeroiai C)Rmida l Water Supply(ahp=4) & UT - M&A
20
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Mrnritarin Reco�Y
njection
Aquifer Reert c QUroundwntorRenmcdiatitm D9 8 t. A LA *Mn
Salinity Barrier r�rioM
Aqu{f�rStprflpr:tm4Ra,ctvcty
llgttiter Tcst [3SttumWaur Drainage
bsidemx Control p.
Experimental Tcetttxlltlgy �
Geothermal(Closed Loop) U'taca BBtL TO
tleothcnnnl Ha ins{�t<Iro) Other ondarA21 Retnta{es) i tr !7b rt_ J! /)/U
Z 6o it. 3�o r� �QR/�•
A.nat�weu�)Cmtmpiec,•tt:� Well 1m1 3$f�n- 3$) #L C-R Cot G e-
Sn.Well Location: �--
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Fat�lih'!t1mv,+ctltmne .
Fwlity 1Dil(mfoppitaahla)
Gle. tr i_ NY 4- r
Physiani Addmc N Cby,wad zip ]IL A 4 r
Couuty pnmcal tdmaiiication No.(Pith ._-.------
sh.l.aflinde and lM)Ptade in degreesltrlimttes/set ands or decimal degrees:
(if well frets,ono lettlOitgin millclent3 CeHFGention: i> 1 S''
�9 f2 Z 8i a ` `tl l�l� �,., . .,��•,,�.. _Z�Z-�ZZ�
DAM
� yi ofCkttifndWdlCaettaamor
6.#tt(a r
1�1're)the well( 1'crnmp'`t►t or "off
i.#b Hmis a repair t�o a—n ezisdtlg wr]#: tidvlG.rlglnS.aIp;;Y CAd n0n2fu_�1fODm'13A,YCAhC7 ft1hX:.tv!?df((IDrj WmeNttC I9mMatmtf1rn
mrainoanmStiahaddo Irnd aatmcrorin,fhrmicfe
Dyes or Ya r!f'fhtr;so��notr,pt!o,nrlh+owr,tivcrl.ronsln,GR�+, rfll$rrnl hor bdo prOAW to the wdt oww-
xrin duqp
uomdla+audnp
p.,toirrmdert,2l'nunfUf *zoo ar all drba0aflbrsfarm. 43-Sift 4fty moradtR mlWdl4100.
YOU may use tlmc imck of ft jvp to provide additional"ll slitl deadly nr muetl
R_bar GeonraMd11t7T or C2q=d 4,mp Geolbernta#Wc11et having the simple ceM9Welirnl rirtails. Yt1u may also aitach 8ddi6orlal PHW tf tlacessery
mamslnectimm.only I GW"1 is needed. fediQM TOTAL NU148M Of%% lls
ddltod:______-„ _,_,_,,,,_..____�.,.... �,nR,.•.-r.r ttycrltu[7ttOiV6 '
.lragt well tlop111pettlivhru4tiN19Nca 6-6 lJC5 (fL) y c du We1L: Submit this form wH1rin 30 days of completion or�vell
PIP,uul+lplewll MWProAPO&u rdi,(parlozanq*-3wQr-7dWWI COORMt ion totticrd1mvins:
l0.Static atNEP ltvt!beleW t+ip of cnsiNS: g (ft- u itlon oPVYatcr Reaow'eea.lttfilrmatl � 1 Unit,
It'anlrr frral frrllvine ctrsln�tar 116171►�t1l Strtviac Cantor,Raldgh.
_-s��cNotr Wde' fn addit{on to pend{tl$the 1ifM tll d1E addt0ay ill 24a
##.RorchotCdiametcr: (1n) �� w Of complt#lcm or Wdl
,Q z ahov4 tdeo Aubmit one copy oPthiti form within 30 tUrys
17.Well rnmtnlelton rnntlod: v T --—� congimalion to the faill
(t a Dear.MMq.cnpla,pirwt Pulls etc.)
)ivilisn OfYf:at+ef fil'eatrrrx.#,Undcrgrnand Injection Coanvl 1Pr+rpratn,
ni m WATeit t+t-•PP v vvra.Ls ONLY: r rim Bull$grvtor Center,litatgo.WC 271 of-1636
24c r_L._..,c g &ioFoetton oNeti� in Anton to:wadies the tbsm to
132.Yield IRi►al) 1►it!ihod Or test: the Nddrass(cs) nbova, also submit Jolla cagy of 1111111 ibnn wUhin 30 days nr
on of yell cosutraetioa to Ill conty health d[PmIMMI of the MOM
where t3b.lNstnfccnan typo: _ Amo,mt natRct 11.
e ann(:1V-1 Notch Qmiimt l7apanmant art:nvlmomrnqnl gmdltu-thvismb oP Wata RmtenT av R�a,iaed3�4 2d1 d
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