GW1-2023-02751_Well Construction - GW1_20230417

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•' ''.144-11 COLUDZI.OP YllftITPritirrt:
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• " :.i-`,a.iiiptor Elazin IA.IWITE7.7..ZONES — .- .1
: well Cahn-at=Mac PROM TO 1 e.
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.. tic Well Caulrattor Cafir=ina Isfutrth...r
/I CV ad'.CASING ffs-n3rit-^zted tvelb.,}GlaT1112,P.(if rIn amble)
• Atitia Drill,int. PROM I TO I rutlimun I isisCia4Ei.:a EtIATERIAL
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316.DM-2R CASiNG ORTilErrie-(F,zollitrtmg clos -kit;*__
2.Well Constulatieu Pert Th. '3 6-1 70 PROM TO I DIAMT":..CE.R TE y
RMIESS I ,..1,......LOI...
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List all applicable e 7!Iceratruction pznlat(Le um c.amie stare,vaday:a.de)
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• 3.Well Use(elleelrwll e use): rt. I.
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P7 SUIEIZI
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Water SupOlk WO:
Agicultural D nmicipal/Publie
Geothermal(liealing/Conling Supply) lA:Rlidential Water Supply(single)
...IndernialICOnnuerchl
! Residential Water Supply(shared) GROUT FROM TO
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lg. ft. I rffmEnx.:th. I SLOT SI•Ez7 THICTENESS MATERIAL
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ED CEMDIT METHOD&AMOUNT
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hlaigation ' FROM TO ' MATERIAL
Non‘Wata•Supply Well: ' 17 ft! it t:t)eirc I,'
Monitoring EiRecoray ft.
Injection Well:
ft. D. • P:
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Aquifer Recharge OGroundwaterReme4liation\
B.RAND/GRAVFLPACI(fif aPtAzible)
EMPLADMNT mr.r. raori I:,
Aquifer Storage and Recovery EliSalinity BatherPROM TO MATERIAL
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BAquifer Test E3Stoirgwater Drafinge
iDExperimentalTechnology E3Subsidence Control . ft• Pt. -
Geothermal(Closed Loop)- - )Tracer 20.DRILLING LOG Windt ,11;11.1irmill sleals if necessary)
DESCRIPTION(color,Itartlarm,sail/rack t5P.,Pr.in.1w-.L',.3 i FROM TO
Geothermal(lieatingCeoling Retina 17 Other.(eplailtunder#21.Remadis)
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4.Date Weli(s)Copuided: 9 ii.-7 VZ1Vall ID# 1/c. IL 2Z.5 ft.
12,.-A..5
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ft. ft.
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SE.WeIlLneafion: .
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'it. ft Playsicalliddrcssi City,=AMP
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L-311:QP-30C. :.
•County Parcel IdatificationNa:"(PIN)
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Sb.Latitude and longitude in degreeshoinnieggeeonds Or deciniail degrees:
(if iTll cirl,one lat/PinglasOiciant)76 22.Certification:
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Smnattnetiftertiqed Well Contractor Date '
6.Is(are)•the wep(s)pce:rmaneni or 0 TeraPorati •
By signing this form.?hereby call&that the well(s)14123(were)constructed in accordance .
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7.iLt this, s.,ipotr to an.exispg,,,,,,n: ov t
i.... .r5At c,,,,vipthyloINCACrii02.ticac-0100.7.1,5;1.ea1V6liotiCie02L020121Vell w.. Constru'itta*a Standards and that a •
lads ir a. ,.6-411"OutraOsin*II Censosdien infbretabonomd explot:the nature of the
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nipair radial!remarhi section et*the Ittick'grthisfbrnr.
23.Site diagrinplor addilionalNell details: .
In the.:_bao10,0:thin'--Page.t9 ftuvide additional niell siW.Y
* details.0 Welt 'ou may
8.-For . robellfirTOrZioieratuijo Giathermal Wells!Paving tile,;amp
., Ruction;:nnlyldW=1"ii=pie&Indica*TOTAl.,NUMBElt of.viells . construCtion decade.Youmziy also sell.sdditional pages lila ' ary, r cfrilim- sumviinno sAL • ..
• 2 2-5 .• - . ,.(ft) 24coa.__ _ ._For•AIL-ihrells:. Submit this fomi viddlin• 30 days dr,canipletion of well
St;Total well depth beinvidiandisurfa cm. .
Farnniptipte wee fitt.. offieP tizr-rflihrethntactzPOk- ii4289'irnd2@wn.'
on .the follnarmg.
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DivisOnWaittritedthir c*:hoiripi., 0:ca.prq,cessint unit, '...• • ift)Stade Iivaterr04 PO.ifk.'!"61. cg.511"g: ' Z1.4:3
constiuoh2lb.ectialsono.tet;th:t67f:;01.4ine eSeptei'vtot7additioibtoCelittenotra;ltd0wohm:en,:dielg.kg3:0Ceda.:Dy7rm:, fUooliteloaltidre$ntw:2e4ia
sion of
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6 •- ., .. (tin)11.11orehde diameter:
Ilivi Water Resourepc
:: 12.Wen.e.enstroction asedaed: - •
i c••anscroatax4y,cable,cruedPirsk.e1P-.) r
1616 ttx,11.en_..--.7-',.." 11-qrground Injection Couhr'I :2 In. .
' FOR WATER SPFPLY•WELLS MY:
-----"'"•°""a°-;enterataleigkisie 27699-1631 Prc-ra -
620 IgethOd.of test:'72/ .- lAe..For NV t •
' 13n.Yield(gem) • . „ ,_,--Y- 21-----, the ,7___;__,..0 e.....2.:smmaw a Tweetion.iv.lla.
1.' ' -. Writ Anasult.', •(602-- - •'''- 'ce 11;11•:f•eiqes):dim,'al—''4-sdil--L--..'---,••:. 111 r41a,...dili• "191e-ilding the f to . .
i ..„...„-4.4.4,;siinve.,:... • • : - - . _ . 7 ._,..___.,77.. .- , lep 4on of well coftstreeti - "PY°- -.J.fOnti*Willi.30 doss f
; z•.Yu 1°. .---!'r. ... . , ,, . . .- , . wher&cpastnictect cm:to the,eau'', iy. .health depariment of tile county
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yeatiOaoliiieDePaaseeforEokuh26may ulity_b .ionloiati;itcource ,. .
••;: Form G W-3
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