GW1-2023-02360_Well Construction - GW1_20230331

Feb 151905:43p Ciaarwater Well Drilling 828-822:7241 ' p.1
WELL CONEIRUCTION RECORD(GW 11 For Interne/Ulm Only:
1.W Contractor Worms,Ion-
14,w,l ;series
i11e11 Con ractotMite + is naacaurtoro
•
?//3 4 . . re- ft.
vC Well GrattaetorCettifwU Wmd� / �/f ' IL Reran COINS ger QRU N Ira }
/J / ///�� mom TO DM NIA'1'itiW. -
(� 11 it. ft. in.
Cominntatlanta Itf.IIVNIeii CA�9akfG UR thermal I 49op)
2.Wen Gmetrtlgkn Permit/l: .WOK tO mamaTJ1l�QYI NAER L
s at aft o y cs,hte t cornav alottpe staOa INC Ca►aly Sm V4 le. rtiace.creJ ' it. tt dn.
3.Well the(check well use): n: tr it,.
Water Sappy Well: ra trhuif1t7t11t titoTlRRs •ratctalDO t+ttt tAi.
E Agricultural [ MtsiicipaVPubl o 0 tt• a.
'Geothermal(Heating/CooliitgSupply) f Residential Water Supply(single) f {I- ten
II indusltiatiCammernial DResidamriat Water Sarpppy(shared) & bur
r irrigation aa+vs TO _ J ■ttdrtalr mthtnacralita��tr�llrnLana�tr irtr
lYeo-W1'nlerSupplyWM t}. Q.
id Monitoring nReeavary te, re
njeetkni•W : .
n. IL�
■ • ` Terlb:A r$t: ©aroundwaterRemediatian s9,4ANAIGRAVELAACKfIf )
9m� OgR Mel Salinity Beerier anew emifAC 'I e0rMclmo
i Aquifer Tot f SmnnwaterDialnage rt. a•
i Experimental Technology .DSukaidencc Commt a. it.
*Geothermal(Closed Loop) Master 20.DI11 INO Lt)C(tell "NNW can)
3Y ttastAamnt(HmtiatgiCacting let area) QuSelt Otbplain tinder R21 Remarks) Ufa rt. m '- •a� unazmd rbodea
511721d
4-Date Weil(e)t�lropleted:, 0 _1 Well IDA a .�Q d
Sm.WNllLarntlna: 6G fiCj) Hie.; rt. it
ft. it. -- ---
rxi«y'()xaterwmc . F.eilt7y[Di/(mfgtpiiraLle) n• ft. . % �'�e 9s,
P Address, .reel ` ,e w ft. ft.
11 G1�1 G'D /V .Pt.lntMAatas irriz ,zi-,14311 vroc::)w:„.'1 1_30:i
Cauaty Panel Monahan aim(PiN) L'r o C) ;,
i
Sb.Latitude seed Ioniande la degtees/minutealstenads ordecimal degrees:
(ir wgtl Reid,one iatllang 5m sulDWa t)t) R
-� 7(%O ,N Qac / /a '�! '37! w - a3
6.Nara)the wdt(s)OAaraseent or El0 eagi nary 11 etc ofCertified WM Caltraccor Dew
By epilog rats Arrn./herdt*ant*char Pao war+)1ms Om)rx.nrrarrad in aronrdmter
7.Is this a repair to an existing well: lows or tYo with l3.1.CAC:02C.QWD11 or LSA Mr02C.0200Well eaeaxaiex ytaxrA,&mei,ha,.r
lf'rldristrrgar.JAlaurbrewwaUaoaamaaeIttfirreoltoa captain timnairar(far v'!y'af/hlt record lmsbegn Mad carjal well ismer npnlrender d2l markt sccflen ornarlteback alDis form.
23_Site dine nor additional well details:
S.For Geoproh einPT or©need-i nnp Geothermal Welht having the sane You may use the buck of Ibis page to provide additional well airs details or well
ammtnuxlaf,00ly t GW.t is needed. indium TOTAL NUMBER of ells cutlStruciion dually. Yam may also attach additional pages if troeesssty,drilled:
9.1'ohtt well depth helm tend surlkec:
Par nearldewrBelim a le p.7..t/'c¢$rrnr rFsanpke-302a0•aada�ra07 (U-} Z+1l�.For Alt Wsita: Submit this form-within 30 daysof completion of sell
con9lrDclioit to the fdltnriDg .
Ilk Static water level Mow top of casing: (tl:) Division of Water
►lwater lime!Isohm tast„s.we-. Resources,Irribrmeatlen Processing UM,
1617 Man Service Center,Weigh,NC27699-16i7
I I.8otmdrotedliatcler. (ln.) • 1.tb.17nr jatcrlirty Wells: in addition to sending the them to the addrrsas in Ztln
12,Well caotatrDcfipD tnefiedt above,also submit one copy of this fawn within 30 days of ectupletkat of well
ac•ram weary.cable,tawpath.lea) canstructiolr to the folitnwitl
DNvLdoi ORYnter HedourlJm Underardluid i adun Centre)Program.
1aQR WATER 1RCPPLV 1b2I 14 Oros!
1636 roan Service center,weigh.PIC 27699-1636
13a.Yield(gm) Method of tesh 24e.Fern Wolar Spntaiv&Tokens!,%lb la addition to
minding Mtil►o itddress(es) above, also submit one copy of this form 30�of
tab.Ulbinfecion t3pm Antostom bmptetion of well consttuction iD the coun •health
where constructed.
deAetrtmenl the county
1vxniOW-i Meth Cbmlinn Dapnrtmon[oFi;nitiiirte®pi Change-t)ivisnu,oPR/eiq:llpgmmt= . iteoiod2-22.2a1at