GW1--04143_Well Construction - GW1_20230623

828.6227241 p.1
Feb 151906:43p Clearwater Well Drilling ; ! .�•-•
i1
nt Ono n
WE IL Cnn1 UcTION RECORD(GW^11 ;rnr 1nt+x�1
Welt Can``rranorgm tR
=-A- ,
_______...,
a.
"I ell Cn l t otCaR{RrO11nn1Vinnhu I-" �' L' i.L!� 1 =isr . :u7I�!;r_. • rt
tufa �A\ - vim .. . t ti ��`,:�. ,r V. •-
4nmiHufvTNme d " litAb3l 1 +. . MA1 Wt.
2,Wall Constrneitan Permit th . __.... iA. ?�
Ma oft npplknAteuvIlcrnistrxatienOwlis au.4pp�Coo of 41*ve rimum•�4)' b. ft.
3.WtM the Wink well tilil'j:
Writer Supply Well: „ , o tti nlAttr tirOr&ns I •stti�lotittae Iuu out,
•el.gric uknrot laytonlalppUPubilo 0 b:
if t:tcainoartnl(tieatiaglConllag5upply) Olden"WaterSuppiv(finals) . tt:' ' tn- b-
A tndustriattCommerche Re:116=W Water'apply(shttrtxl) err • ABicn• " an ] ter 9 a' _ PLA - .
trk
NnR 1��n1ir Sappy Well:
01 Monitoring Reaovnty -- _ • h. F`
Inieb[iPn Well: _ ' R. W. � _...
�'Aquifer]tedltirite ritironndwilterRclncdisGon L .
ic�VRLFACI!! I +l l`e " "te�ron
#� quill'Srort+Ra trod Recovery �Salinhy Brasier ,_w
fil AgnifcrTcct
3ttgmwater Drainogo n-
I1 G perimental Tednotnsy 13Subsidenee Control O. ft. . -
9( ,.,f.r
II(isothermal(Closed Loop) �1 s LtiGttltd
X Otagoxmat(N tin l mu),•,7,I3altt�(°ePl°in undor")Rcrnxrtss) ,•i ft. a• '
4,hat W II(t) Icttr+t:S-IS well r # }57 R � n A
AV7r
��t , �taCe i 4 V'• uos it .Ifl Lei
' - (r, l' Cr .�..r.
FaCility
i grey,RV(i ATIlcabte) A. ^. r'E I V ,
,. l�l�NOW1 �I VA. lars�h 11 IOC w it. ri I Juti 2 ; 20?3. .
rrnsr�rntAA+f4 CUy.and Zap
1"\nRS I ..•..
t��n --•- dsr. ilt�ter �eerg lira,
C.muy �' it
Pita'Identification ttn.(ptN) I t�6'+t.)rfi3''Ja'
Sh.IIttitudn and longitrldeifdt;qn/inimtlestnettondsordecimaldsgrecs; t
(ii woil f hl,da1R Wirth;t ado° r g2. , anion
5 • 5U SOZ N a 31" 1 u9 -2 - Z3
sa ol'OrnIfird9kIlantrottor Dab
b.Istnrc)the wdl(t! i�e at�frrnanent or Direndlerarl cw ntdadA►nrnnrdmrcr
i.is lids are airtnanaidingwcll: 1.� trill,,st!!C.tCo21:-#WOM•)SA.YCACA7!-'.QNN)WdlConrintctimr9tntn8tmkmnrrhm,r
Yes or bll�g rnnp410mordharA 1Pmr 'Whew!,O ,
Iftlik p nrsmlanmt ptaO•th won i fdm
Melton erAlr..etlonul3t 1I rvutno*lctfM of
23.Edio or atiditlotadvaddestRa:
Melt under Ali raitelsicr:ax►ldn ono* ocovidosa ;Wit 8110de:sib wail
8.For Gen trnst clDPT or Closed-Lem Wellsriavingfic scone
Ton may use Ittc back DTtitm also to e
i' p Oik81 W1
ra419trucliotlthtailc. Willow AflAll sal 1 Psis iFtloeesaatY
onnatrastitln,onty I OWI is needed Inducts TOTAL NUMBER of walls
drilled. • ... kragenaltli
9.loud weltdapm Mow Inns sorties: O - (11.4 24a. For at1 wcilst saline this Oren within 7 chars of ooMPletirm of volt
For mulriplawclklitonlidpthi cry'eruar(esrmpla-3t120trandMtrto) arnswartionto die following:
In.Staciewaarltvw elbelowtopofineing: (It.) DivirlonofWaterRe rowsrs:inihntiatlonProcessingVolt,
{/'nntarttnv1Istraaearh+p,ere I(" L 161'fMASoria�1e'+ 9b'14C27 -15!?
11.RorebotedIamater: l , fin.) hin BajdodilandliF to addition to soodioli fire WO die slam f Won
*ow,also submit one copy of Ns fan o wllhht 3e days
Az WWI conetrlsetlan mettlOd: rptaNk millsltat fiolrtothcfollonnlV
ti o,rugs:,rotary.cable,dime whom.)
Division PfVlt4[!T'$l'itlplltOldrUndL'Igr�tYfldl�trcftoA Program.
MR WATER lit;i'I�lf'WELLS;llvar. ILA 1635 m llseslvioe cam;Ratetal.INC 276094636
� �p - taliudditloat to sanding thetbrm to
L3a.Y1sIdIRPmI, MolkodaFtr9tt the nddt+ (c) nbovn &so submt one ropy of ddts tlsim wi1hM 3i1 drys of
csnnpletion of well construction to the county health tt llItMettt Of lest many
tab.Disinfection ty (� ,Amount. w)nre eom+anmee
IomiOW-t North CartemDGM entnettnvtc1nm1 ilQ iv-rllvinunnewsier Itausurens Reubed2-22 016
I

We II Driller Sall-Sault Cartification
Acne. ) CGt5 l IC )pIocL //
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Owner:Q x. E, J ert i ' @ te�,well:
Addresf60 0.P LOUAf - (La Repair:
permit Mars ( ►JC.
I hereby certify that the above referenced well Was grouted in appearance in .•. ' • with
all Cowry Well Hiles.
MalaelP
Signed:,WmDriller• .
Certlficate#: 2-t1/43-A d:S I 23
Construdfcn: Groin
CO 01-
Total Depth; .
Type p\i C. Thickness: (`{VC 14 C� .
Casing : SD, Dot:
Diameter: CO
`'
We littThidc ,
Height.
Drive Shoe
GPM