GW1-2022-06467_Well Construction - GW1_20220519

• 828-622.72,41
F-ab 1619 05:43p GlealwaterWBll Drilling
"For lnlclmnl Uso+3niy;
1>ttE'�.L cQ]T TJCTION AcERn LO V�).
t.711CgTotrattnr Informatto -Il oN(6 p-- 'V -
it,
+ve1t(:antralttaTfame ,...._--- --..... �
2I63_ /7 • . Il: --
+lC:WoUCnntraporticclitraatin Number !g li Cs ma (bctAal A �+ t:1:5 r i.•'' ' - -/
/ _IIYIRM tt, ia, 1
e d e R u1 tea. ft.
Company Tromn ��r�.+�� -I tb. 6R ti T� IotA thergotY . . limp, t, ._
7..Well(:onftrnetion Plermlt at•
Z'�2� - �� . "' "!"� ft- ~ in. -
[t.
,.l.rrall nppffmhfu Iva eanernrafion pumas 0.0,WO,Cmmry,Sfafo.YaHnnce,r.K) -... -—"—-in
s.lY1111Isc pod well Mt): ---•-• •-ils �,;14
Supply i1• - ppm lallerr.r..1171111 :a :i.
/lgrieultltrnl �MIminlpaliPithilc i:1
Ctcaltclsrwl¢ieeling(C:aatiagsapply) Rl:sidemtial Water Supply(single) t+tt. _
. lin MOM
insosuini/Commewlaf Residential Water Supply(aharal) "'"g, n' t11T-'f iTr4.
.,. ' to r 0 it, NON Dr{ orlon -r-.- --.
Van VI ntgr Supply N'o11: to, fr- _ ��__ _. �
fill Manitarin: _Recovery . , __ _..
n tenon Tr• : n" It - ----
ill AqulfcrReeUai$e Clroundwntazttemediation �^ni .r NIL.AC. (r, .1,
11 aquifr:rStvrapGtRtdltF+liW ' E-ISNini !Wrier to.
1111 Aquifer Test EISmorovatat Drainage -.__ - il� �--
1111 L"xilerimemal TechnologynSutwidcnra Control It. ---
It Geothermal(Clotted Lo01t) Crowe' :atii,r
p til7t, t, ;- :i ik �1„,.,..-. " -_,
111 Geothermal(Roati oling Ronan) oihel-(a x lntp .-upder1121 Remarks) " to s) to ' `3 O_ �" - [ -1,V� ._--
A.tMtt:wolpt)cornmeal;al;3 Z' Wall 1Thi . . N t
So.WritI Location: rt. 121 \ K.V --__
GneilihdpnmerMmnc . F,aeility ID l(ifigrptleAble.) �--
P elrci Addroxx t ty,and Zip R --
;;IEi, :� --� MAY 1 902?
Comity Parton tduntiScmion No.(PIN)
f b.Lantudn nod longitude in depramiallnatesiseconds or decimal degrees: -------- 1..1, - -
(Jewett tratd,cum Milani;fnsuinalcnl) 0 0 y,2rerdlicntion: i of°e70 :,,v .`1'.78T_..: ",3 N;L-
fi 6uc cif 4attriorivJcllCantmawr
Dale
4.motet)the well(R) Permanent or ElITemporary
.li i,r/grums Deis.0,,.rr,7 porehy rmrtio tool are wc1164 oric(wort)contrition!In Agana/me
trine 1.SA ie,4'NC-00 or 1 Sil ItICAC 02(,'AXIOM Cmirftnrfimr Simrdarda Ma Mai it
7.to this A repair to an existing well: f}xea ar tgliNto „ !!d v err vmf(roe?. n piSt td to rife wall im'fl r.
r'fM.r;soryrafr..011 nor/Immo endon..lraeiran+it/armeanmite-TPA;; Dimreq ion G/.1 n
ra;lolrunder Alf remarks avian or art flu:OM*afMix form 13-Stir diagram or additional wall Mails:
R.For Geoprabemt'Tor Closed-Limp Geothermal Wells having the seam !rail may else:ate back of this pagalso to ixovldo ildons!is pages
well site salmis ttr Wolf
multivalent,only I GW.I is needed. huhlanta TOTAL NUMBER of wf:ll,
aon.9tructiaa Mails, Yon may n180 pttADh additional palpeg tFnoo��v
%row waitdtplii POW land Ram,. ff.) 2/Ih. (Fa lLWirl o! Submit this S'OMI within 30 days of completion of well
FFnrtxnhlplcweftMrat depiluiIfdfaraar(krnmrp/a-3(n?T4lranoi.4100') construction to the following:
IO.Stink water level Maw top ofeasing:___. . _.....—T (fr_) Divlalna r�rR l vice p�I I�g �G� �y)nit,
!limier kw!IT okra cnitoli,Ma"'
Ii.Borehole diameter -C2, 1 Y. (In.) ?p.Tier ta, ■u t,Y,gslign walla In addition to sending the.time to die address in 24n
above,oleo Submit one copy of thin form%Albin 30 days of completion of well
IZ Welt construction method; - -.-.--.- - construction ro the fotlowinZ
(i c,nage,rotary.panne,pirol poll,tiM) aR
.—,. � 1)!Villr+n Ol'�latel'�ttanttrCi3r Underground i !!flan Control Program,
iADIe WATER SCriri_v WELLS ONLY: t G3li INatl9ervI isircr,Weigh,NC�'/+ 1<b'3G
135.Ylrf I Won) _ \ Method or test:, 2Ia l��or Water Supalv&IslacilOa Wei: in addition Id sanding the tom to
-_v- tutu llddress(Cs) above. also submit one copy of this fomt within 3tl days of
tad.1)►stnrecttnn t ,Amount: completion of well cortstsuction to the county health department of the cranny
typo: - Inhere conaitwcted.
Irrrtm cur-1 North C.hmlInn Dannmmont or'LuvImnmr•.r,oil Quality-t)ivisrnn of warm.Amount*! IlmrirEd.2:21 2616