GW1--07183_Well Construction - GW1_20231101

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VfVELL CONSTRUCTION_ RECORD_ _ _ (OW-II Of I�tr TT ta O�at�;
1.Weil Contractor Information: •
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NC Visit Connactoct otiftcstion'limbo- ;:a P(i ' cni} �rensAL
Morgan 1Netl, s Pump, ' 0 ftJAW-10 DIAMIng-t;tl9 ilk 0 Fr t}v� _
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7 ( (NLI IF,(� �$OM 70 _____ R 31ti4t4N133 1141 SEAIAt _
2,Well Construed=hermit#; -�l _ ._ (l a ft, �.
Si"ram,ekl
zisral_rc�pTuabte well aoastrvet=a!'iPs"+s'v
3,Weil Use(cheek well vs* l7 stl .., . : „
-- - v I lAAtbTER S[ATS Z roams; AMATERIAL _
pter�trPPt}'Wellt
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IIIAP#ic"-it�i t Supply(sires) ft
eatin8/�galiu�Supply) D1�3a.lNsli�r. -:.:; .._-,.
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p „nAtvatorS omodiation A TO
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r Aquifer_" OStattnwater1 i �_ ---- - .
iii Aquifer Test 1�
_Experimental Technology �Snb t Control
Tt ?0;ZOI1LING1t 144Al l:kifff' F
X Geothermal(Cktsed loop)
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FROM A .UtsmornOls cc M$1 3.alWrss „• iSSc
a t(Hearin C9sIi.,Sa) �Other(explain t 1 tzritks_ _
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4,NU WsLl(s)Completed; L WO # mit �itruinvinir,( vrt
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R�scalhbtntificasarl o. - — _ iiIi3i—C,.—..`:f ?r:^ '':...
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3b,Latitads and longitude n r nut !sera ' - " �2 _.' _._tioct 9,
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6,We)the i s) gRnwtttetst or s Tstt►F°rnr}' Hy evingthl7fano,d hereby are het the'R1(sl weir Owns)s nitreclna in areorennec
RI No rgi NS.iCo?c.arpa or rid xsa�aaC,oz4f1 writ �+r±tnutran Stvnderds and that er
y gthis2lr A a it iAlaw l ®HS.S to 3 � nthen we If gr ward halb+imPrev motelgltms*M
rre repair
oter#21 j aw know l an the b tlon of this
*melon�rsd r 23,Sits d or additional well its:
rsj*utrr#2l rsmart!�ecannaronikabachaftMJ
S.For Geoprob013FT or Closet-Uop
?lac ytest U.a back of this to Sn°f" motional Weil slts dtta!Js or well
GrotS ennal Welis havingthe construction oss details.beck
You is p attach tfgtdi ions i nsc >3
Gs>tE3tn�et�4�,°A t�W`S n i�db is T L]+ttJMBF�R awaits AJ17AI IiFa"'RUC1'T��i5
Wiled:`
p>�iandwell depth 4slawland surface;, — 00 Ma,for M_wens: Submit tkii ft within30 days ofwmpietion of well
• Far multiplexrBslut all depth:V lifere±t(ample-31 0Yan42 It col tnotiontoLbef'ollowing; ,
Slade water Ssret below tc gsla i c gs L1 0 (ft.) Pivitioa of Water-Rswlstses,Information Processing Unit,
10. 1619 Service Center, ,1 iC a7k99-1657
Ij',intrrJes Janbprecnsn use"b"
'`�/ 24b:For Injection Wens; In addition to sending the form to the address in Ma
f},sore#tsisd'safnstert___----- --- °�� — - above, audit one copy of this form within 30 days of completion of well
Sa,wsll sotratrtretioe method; - -
fAt- - r. construction to the following:
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i+tgcr,saw,marry,cats,direct[euh, ) Division of Water ,{'tlndsrg?000d Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
163614fail Woke peoter,llstleigh,i4C 276994636
oir 2.4.For Witten•Swmtx&iaieetion WeIIs: in addition to wing tho fort to
,� , ilEetht)d°f -- - cs above,also submit one copy of this form within 30 days of
S9a.Xiu>;Id(gem) � tits t�lse�si }
at4A et fine + •S � - completion of well constrecction Ito tho county health department of the county
S3bPtsznfeeti9ntxps;_ Ammo
North eg2llooDc ±tofPn ntolgratify-DivisionofWAPItrsoo
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