HomeMy WebLinkAboutGW1--04836_Well Construction - GW1_20230728 •
Feb 1519 05:4�3p Cleetwater W$11 Drllling $`$"622»72A'f ill
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Well C.oniractor Warne
me Well CnrtmdaTCettilicnlian Humber pRit C1491N(s le0r [Ifu�p�4tt}
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Company Nam: _ �c�l �^� n I^ ��
2.wall Construction Penult at `" - V 1 V O L1[ LO �R C�481NC om nuFttTIIi os� 414iq , stoma
UV all applkahlewalltrntstrraionpw1nfaatt.IIC�Comfy,Sra1r,Yarlinuc,er,J b- ft.
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3.WM Use(cheek well we):
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WraterSapplyq ptcH: "--rust 2ita dwe _Irt e:au_ ru►'rk MAI.
D6Sriclllntral 101lirunioipaUPubUc 0 ft. B. int I
afeatingtConlitigSuppl_y) t3Rt:tideminl WatcrSupply(ohmic) ""' ft. i.; ' Im. t
fndus►riatiCommerattti fliieidenttal Water Supply(shared) 11t , t` '
lrti Illifol ,...ION TO 111110 4 Otari RL`ll[ia`T'MMODis MOWN
Nutt-Wnl+er Supply Wag) R a'
DMonitotiw$$ PReoovary - tt•
Injection l'1�tt1: D. R.
Aquifer Recline J(1rmindwatcr Remedtstitm
Aquifer 18 - .n;n; •VPLP-C> L .__...
Agri QT1Ij and R7ecnv r3Sitlinity Boater Rc� R 5 i ,n, c �•.i non
Aquifer TO �AtnmtwaterDrainuge a-
ft. �'
Experimental Technology DSubsidenen Cotttrnl B.
Geothermal(Closed Loop) Okaacr ( 'a i�ci .-.L _�'
Goodman!(Hbflgn lCootinR +a3) f Plain under ik2)Renaults) fu Kil O. '. ,_
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E. .FacilliyltlnnerNema OkK1 e1-4G.F0.11n11•aiiibrmD(ifamatexible) °'
� Pa oar'Tr ,ShD�y line. ivC. ,� 't. b. ��` . - : la
Pit seal Address, and alp d 7 fl,q
Calmly Sinai Idontifieation Igo.(p1N) " 'r '. II
51).Latitudn nod longitude Indcgrrdslminuteslsenmdsar4ceimnl dagctic ( � `
(ewe!(kld,ono latrionitis ttitiiricnt) 'M.C r exam
Wi 3R' 112— ,I V(521 3 (t-ale w U — jq-2
6.Ware)Mrwdt(a)aermasteot or �1Tettlpornrp Signal aofCkntGalvVeUCaetitalar Bata
AI,dpnwg tors_pm I nen./.pee,IIfy seal el le udl()scar grata)Itatunstemrl In nren►dencr
7.t1 this a repair tnascsintit well Intros or CONo wish}SA iCACO2C.410Dor15A 1C.ACO2C.Mlle Wel Conrinirtlart9tmrdarrtrl><ar due a
If"iNareltakfllloiwkdipWnWQllaaomrucutnu i+man:namtderldlanrtl,.mdu„ppha Cipl,fide;MordhaRhz mpM iii e d Mix will owne"-
ner&irwiderG21rahin.tL emnponthe!sic a thls.Polm.
13.Sue trainman)or additional Weltdotallst
R.f or Gesprt/bNAPT or ClOred-t oup Geolbtrrmal Welts having thasnmt you laity tree the tack of drispagJe to provider additimtt►1 MAs li details tm well
oansinictitut,oniy I Ct1N)itr muted liidicate TOTAL NUMBER orwrens ci3fltt1Uctioa(blahs. WM trine also Mall addl(tonal pages if ntirfistary. .
drifted;,, ,-• 3 Use S Z mo'1Tdi lI TRLtCgf j$
9:!saint welt depth Mow land sotrtaee: (L) 2,16.For All 3l el o: Submit this Ann tsilt in SD i days of completion of well
For f reinnIalcwenpliwali&vaindJBermv(esample-3010lr'imdst@ta01 ennsttucliontoMcl'olletwing:
i0.Stab waterlevct beh w top of cesing. (it) Dividoe atWAter Reram'cts.IIaibrtaat!oii Proeelaicg Drift,
Ileaterlewllrabareenplagwe ' NIT vice Center,Rtt ig NC31694-16t7
IL Borehole diameter: (in.) 2511.Worlwicitly)Wdl3 io addition to'Minting the titan to the Wan in 244
*ow,Wm Submit one copy of this form within 30 4 ys of eempldkte of well
12 Well ennetnetionmethod: ®ifistfutnialtrt.the fallewinl
ti o,ono.,minty.talk aired puth,Cte.)
---,..-.---_ - . Miami of W1ter Rtxlttttnest Underground t�jmMloa Como)Peoprant.
POlk WATER wpm(WELLSGN1XY: 1436 Mall Service Center,RateighAC27 T&36
Mt.Yield(gpmn), Method of rest: 24c,go-wider Suneis&trafecttOO We In odditiun Wounding the Coon to
Ma addr os(es)Anon,also submit one copy of lthfo than within 30 days of
i3A.Disinfection tYp �„ Ammo completion of well coast mcdon- the molly dkpntltnen county
- wham commuted
Farm C W-t Word,CamtnmDcponmantafiinvininmtmTalQiaiity-WantorWezet'Ratanreas Revised 2-221016
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