GW1-2023-02035_Well Construction - GW1_20230303

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Feb 1619 06;43p Gleaeweter Well Drilling 82$$22 7241 p.1
wEL_?�0„1. UCTION RECORD(GW . F. Fnr Internal Use Only:• -
1 1CantuttU r Infbrmillon:
ill WA TES
Wei!CONDOM NMI*
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NC was CmtttapaCrsti6a.tlon Number
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IS OUTER G(far
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Company Myna
2.Wen c or V ref I —V09- +i6.Maras rcae �
fist all Construction Permit d: idaoss stp ate b+tn�ititt,
affikoMe uelfc:mulna o porpen UIC Comet Scale.Ymlmiett ate) . ''" fk ft. hu
3.Well liic Oiled wen use): - rt. tR a.
Wst&Sap*Wen: • tWRlfilp►
■ alkaltIllal DMftaliclpaUPgbNe Roo• ro DMTLOr A ,fitaTTITO TOICONrse WA ttAL
0 n. b.
IIICreaMmatel(R 8 Supply) pkceidentinf WaterSuppiy(single) - e. ` ft. ill.
ill[MgthiafiConutes ram) DReaidattrs[Water Supply(shoved) -
111 kri•,, on •-kw
�IPP m 7iWA' insltantatottr Aitnpgyter
Non-Water Sup-ply WA: • rt. . 0A-r1 (�
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al Monitoring ©Recmooy ft. �D to O. s V� I x� �1 ��\
njeetloa Welt •
minxRallslgc n. ft.
ttyB
antiAdialitrreturnots
�'A9tdfee StorAgo et dRtnxwary C*in-'_,1ttrriu fStSANWORA PACK a
AquiferTe�t �StiuliRiYtcrDmiltegCC tti e. ���
*Experimental Talmo*/ rILSohnitlineaCnmml n. e.
•Geothermal(Closed Loop) Erma 2s}imam 1WGtoo a)
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Geotpentud li Return) de�� iaundnc#21 ReSitarks) PROM To .00,1tr t..%0....er.i
./.Date Well(a) <<--2-2--2y`ell IDp it. t, (�,
sM,wdi Location t�i e J�i'11 11-15 •Q Dtt. W r 3 ft JNi,'^l i Q
C�,n`te,�'1`GCl s �-h�i�-�� io c.c r���.�,i�'Ce .
�3`, —lc iR rpo R_ilk
Fan18y?ts.,,,a>�a . Facility tRN(if applicable)
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_(( • r\t/i t QC t* fr. .
oat+taddtnet,crly nnd2ip ft. ,�� fr " {;
i fC MN, • a1.JTWntAttlin =r �. ....
Comity Patted idami1 etteee 1 to.(POI) 1�A R .� i ti .i
(ib Latitude and tongkude in dcginedatillllteafgteMids er decimal degrees:
���weileae i0� Utt
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6.1e{ate}thewdt(e} Pamtlnrnt or �17smltorarjf SiEamIweotCaitradWelieattiaetar Dale
i.In this a repair In an L�r 1p a&Ream thl form.I herrtt v avant.drat die .�j tad Mme1 cownwri!m ens c r cr
lfrin Is existing OYcs or ttNo with MAPinta02tAl00orISA.vCACOC.1lw08WeNCnutotiednrStandedsrmd+M+a
r�7+nlesatr ahtfIll°whom:11Whmarwrrta,a/nrumtnaMaRpl*Memnoreribc enpiofrhbrremMhaebaeoparuedmrhexdIawtia:
taatarkt=that manilla back aftkisform.
2.1.Sib diagram or additional wendeeaib:
S.For GeoprrolrclpP J or Gibbed-i nap Gent crnml Weill having the sic 14w may use the back of this page to provide+ddilionill well site deter tr well
exlnalntetian,only I GW l is needed ihdieato TOTAL NUMBER awaits
contraction details. YOU may also fatal)additional paw if fteecasaty_drilled
Total+PCtI*pat AuBh lrrAL irifin fame
at
pat MUD meet sadism --I OS-
Pro)
abroad/►!./ewear bgautrepa l wiffercat fr�mA{e.39t309`smd.2011"7 construction or A�WOWg t this fifift-width' 3O days of completion of'w JJ
lottJafbllowiSinlog:. •
M.stir water lava l below bop of casing: (Il:) DivJt n otWatcr?lemmata.
limierlavaiIaaharacasin tee " ldbrt..tlout Processing1 n \i 1617 Met!Service Center,RtfefBb,NC27 7 rtlt,
ti_Borehole diameter: l31' iin.}
• ?Ab.For itelnctiott rYplls: In addition to sending the form to the address In 24a
1Z Well ametroetlolJ Method: cb`1'CIi _{
above,also submit one copy of this farm within 30 days of completion of We
(i e.angel leery.table.drat e1e.) CDIISi llCltntt to Me foifollowingwon
Division of Water Reeotrcaes.Undelgroand ig(ectIon Control Nonni.
lt0li WATER i4l'PPLYVYEI r S ONLY:
1636 Man Service Caner,Rateigtoic 276094636
13e.Yield(gppt)- CD. Method of testy i2.-t s i_ 24c.Nor Water Sanely&i'nfeetsn Weft In addition to sag
ding the addrenn(ao) above, also mubrtt onethe ass of
e36.Disinfection type:.. .. Maui!: copy of ibis department
30h days of
cam of well eorsatmct;o,t the canny health the county
where constructed. ,
teem GVI.t
Muth CendinaDopnnmontafFmitti tivitiaiQuality-OivituataWat4 poront= Reviited2-22.0016

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