GW1--03967_Well Construction - GW1_20230612

MEXL CONSTRUCTION RECORD(GW 1) For liftmat Use Only:
i.weti COntr2ctor 1(nc`oErB aum
-T ti 14.WATE_2ZOM
1Vcll ContracturName MR061 TO DESCRIPnON
D,4 9':�, A 3%() 3wL
,%oIt- ,A
ICVt'cflContractorCeniScadonNumbcr 15.OUTMCASING Ifin-mula-ensed mmW ORi1VEIt CffM Iel
Stephenson's Well DviIling, Inc. MOM ITO MAMA 7MCIMTESS I MATERM
CompanyName (3 m I o
ft 1 a- SpP al ° V C
3 I&_ENDMR C ISMG OR'i:r le ING( fiat erinat closed-icon)
2.Well Construction Permi'tir MONT TO Iranacrca TIUCIGIM&S �se�tiar
Lit aft DP. lfcab[aIMHcanrn-umdbaFM-itsrre_UTCCcrurty Stale;fors—ems) A11Aa-
3.Well Use(che&'Mell use):
Water Supply Well: 17.SCP bt -
FR03i I TO I DL1itY=m SLOrSLr IF.FCi{t.'E55 H&TEHL4I.
DAgricultural4rmieipaUPnbHa ' :-,- I mtt_Lt, I
(3cothennal(ffcafin,dCoi)lingSupi)ly) N12fR&dc t al VJaterSupply(engic) �-
Iadust aUConimcreial. DResidentialI.Vatu Supply(sharzd) :s GROi T
Likrigation
Non-Water Supply Well:
Monitoring 0Rccovcty
injectionWeL: 1, M
r fL
E3AgetfcrRecharge F-1,G.-ond—w-ieritea- 1.
e and Rec Z9_ Ga 3S r~.P4CK fu fable)
AquiferStora�a ovcry �ISalinityBarier. Fa r t TO B31TERIAL .51PLACE'4iTL•P."rtimCTHOn
DAquiferTest DSlozm%aterDraimRe I it. I f -
ExpenmemahTechnology flisn—a
Geothermal(Closed Loop) OTracer Ft.�R-7i'mG-* rf�e�.dd aaals5z ss� r
Geothermal(Heating(CoolingMum) FJ01her(,,plain nd_ 2_1 Ram- t;) III =?OH 1 To
} 0 f -fLI f
4_Date Weil(s)Completed:j,�-aG-X3 Well uk.- ( `''• 1 tott. RoAt -ClINNI
So.Well Location: 3 fr.
�IoJocK i 63 ft I5a =�
Fociiity10nmcrNatuc Fb ilitplOd(if=_—�
y 1 e Nc; I `<� f4 �~a+.�, ✓ rt �..e
3 S6 S TC'aPPQ,f d' KLAM WC& for . a1 Sri
rlt.sir al Addt .c �� M. s J U N .2 2023
I�6a.3V®--Q%ITA 2'_ILt'ICt M'
County lId--ud- —Iballe_tMD - t=
5b.Latitude and honffitade 13 or dedm_dues:
(ifs.art field,one latilang issufckrit) 22.CertMeatio
o.fs(a,-e)iFierell{s) Fermanenz orT_- o2 St 17cllCo r Data
3Y siyaiag Arms ff?=I h—hy— 6.than fibs t-UN s:us f-re)cc=rurted in accordance
7.is this a x epak`o an-is'tin -v elk oives or.Z?f k. uvh 1 NUI C d?C-I1190 a--ISM:YCaC MCM299 Nell CDrsrruVion gtardards rand ilia,e
!ftltrs it a r�rair fdl oat larors7r weX canstrncrian Warnratiori mrd explaa sire natarr afilte can,ofthir rrcard,=been provided ro tlta ireH or lrP'.
rpair under#21 rzmarksseaian aron the bark of thajars
23.Site diag--sut o2 sdcuticnal rove,detn35:
S.For C-eoprobelDPT or Closed-Loop a^_eothermal Werw having the same You may use the back of ibis page to provide additional well site details or well
construction,only IGW-I is needed_ ludicatcTOTALAICLIVIBERo£wells constTuctiondetails_Youmay also attach additional pagumTnecessary_
drilled: 1 5 3ai�±g2�iC �Ius
9.coral FaeII depth heltrIaattlsnriace: (a {�) 24a.For All NJeils: Submit thus form within 30 day,of completion of well
For multiple vrclls list all depths ijdr�r�ent(esample 3Qa ZQD'and 2QIQ09 eonstmetion to the followin_x
10.Static water level below top of casing: 3 V (FL) Division of 74rater ResoureE 1-hl'orrdatran Pro cessingr un%
Ifunterlaml fr abar a csia.use'-" 1617 Mail service Center RaIeiab,NC 27699-16w,
1L Borehole diameter__ EN__Cm) 24b. For aueuion Welter In addition to sending the form to the address in 24.a
`/ above,also submit one copy fntm of this within 30 days of completion of tilcll
12.Well construction rrre_horl: �1 r I/�\d�C^f Y construction to the follovAns"
rm auee,rotary,cable,direct ptsk etc)
D=vuor_iarVat on
_ es,U:i2ae-gseaxad EajecSori Control Program,
FOR WATIER SUPPLY W11M OIMY: 1636 DIall Service Center,R.aleiglt,NC 27699-1636
13a.Yield(+pa) it ethtrd o: t: Q5rWAS%. —"it-For Waar Smnly S--xSsr2 n VON: 1a addition to s=ding the form to
the address true
address(es) above,also submit e My of this form vdthin 30 clays of
13b_DisrDfeetioa type: I ��_ Amour compledoa of •all cassttucif a to the county IteaItlt department of the county