GW1--00096_Well Construction - GW1_20231228

ii
WELL CONS UC ioN +CORD(GW-1) Forintemal Tse only_ -,
1.Well Contractor Information: I 1
- i� Pao o L. ��(av it IC WATER ZONFS I ;
1, Well ConnaetorNetne �/ IRON Ito I DESCRIPTION
lI1; 3.1C Well Contractnr Certification Number � t'I I
i 001 `_/5 Wei! t 15.,Oi [t I/ ! /�,p C SING ZI ail).(forvivid-casedwetisSORiail)iicahie -
vt
f lJif ��1 j{��l (J 1 TO I Ei aorrna ciomS+ s MATERIALRiAL
Company Name in. I
v J
1'.; 1.6./RIEg.C.ELSINGORTt1BINGfgeothermaldased loop)
l,1 2.Well Construction Permit#: 1 Y6 53 PROM TO DIAMETER. THICKNESS MATERIAL
0List all aop1 calile mil construction permits(i.e.UIC.County,Stare,Variance.eta) ft. I j 'ft. iv.
3.Well Use(chesltwelfiise): ft. I i ft in:
`!! Water-Supply Well: 17.SEEN I• ;
FROM
l IC111tUIal � TO i DIAMETER SLOT SIZE TR/CR/MSS MATER
bAF"j, pal/Public ft I ft in.
I(f,: Geothermal(Treating/Cooling Supply) ti Rcsidential-Water Supply(single) ft. ft in.
j I • ` Industrial/Commercial DResidential Water Supply(slated) IS.GROUT I "!
,
Irrigation L PROM To' i MATERCAL EMPLACEMENT MECII D&ant
I,; Non-Water Supply Well: 0 ft. I m p•
'' Monitoring Q}Reeovery •� !� i p
�
f'' Injection Well: I j ft
i i • Aquifer Recharge DGroundwaterRemediation i
rStoma Storage 29 SAND/GRAVELPACKitfappficable) -
��i' Ate g Recovery �ISalinityRanier RROM " TO, I MATERIAL EMPLACEMENTMETHOL
Aquifer Test DiStormwaterDrainage ft. I ft.
Experimental Technology . DiSubsidence Coutro) tt I ; ft -
Geotheamal(Closed Loop) IMITracer 20.DRII.LIPiGLf1G(attach addiBofl sheets'ffnecessary)
FRONT TO GeothermalMeeting/CoolingRetum) flOther(explain-ander#21Remarks) �-,' DESCRIPTION[cotorhacanesv,sa�roctcevoe ectas;ze
4.Date Wells)Completed: 3 n 3 1-2 ell UY a 11 `V 8 it S et.cld 5�'"r1
5a.WeilLocation: 7o ft- i got- 1 fide 67 '14
f eq�-/os G4 tic) q (p f Di® 6 �4,
r�niaL�
Eac /OnmerNama ft I ft;
Y. FacilitgID#[ifappGcahie)
11 PhysicalAddres,City,and Zip W G. -ft. • 1 ! if. ` e fR r 1 „, ^-:
A o�►13y 22 a-•""h; ,y
— O 21Re2v€ xS ; • -
' _ Caanty . PatcelldentificatioalQo.(PIN)
20
•
it r7;i'r;. v
.i 5b.Lafitude andlongihrde in degrees/minutes/seconds or decimal degrees:
(ifwctti/ifctd, .jatilaagissufcient) Q P /� I ;� r
` .3 1v,'� S�l� G ` • (� _ 22.ti'erttf"I£StSO t' C `"c":; � !
1,; 1 1 - 3-31--z3
6.Is(are)the well(s) ermanent or EfiTemporary SwntumofCertifiedlifeu Date
By signing y gni g this o 1 hereby cerGg that the uell(s)was five re,)constricted in acc
` IEEEf
I l 7.'stills a m epair fu an existing well: Yes or O with 15tlNCrrC 0?�_OIOO or jSiiNG'rjC 02C_030D Well Construction Srandardr as
• Phis tsarepairfrll out balm well construeuoatnformatiop anti explain the nature ofthe coPY vfOlIsrecatik W s6rrapravidedtothewvellmvner_
septa's under f21 remarks section or on the back ofthisform 23-Site diagram er additional well details:
S.For GeoprobefDPT or Closed-Loop Geothermal Weltshaving the same You may use tieback of this page In provide additional well site details
coast action de You maypages
construction,only 1 GW-1 is needed Indicate TOTAL NUMBER ofwells also attach additional ages ifnecess
} drilled: SUBMITTALFNSTRDCTIONS
9.Total well depth below land surface: 0 0 {ft.) 24a.For All Wells; Submit this form within 30 days of completion
4 For multiple wellsltstalIdepthsrclffereat(example-3a 00'and2Qa1(703 constmetionte 0owfol n
• ;•1 waterp g `1Lt'J
10.3tativel&ab Iecasin ,use- afcasin . ( ) 131v3si�onofZYater Resources,Information Processing lTniy
,! llttaterlevelisabovernsing,rtse"r
1617mail Service Center,Raleigh,NC 27699-1617
' I1.33orebosediameter.
`� (in .7.4b.For Infection Wells: In addition to sending the fomi-to the address
;! -12.Well construction method: tit(t r • '`"f r y
above,also subipit one copy-of this form within 30 days of completion
Cie-auger,rotary,cable,duectpush,eta) constraatio- i e,fo724wIDg
• i Division of Water Resources,Und nand
FOR WATER SUPPLY WELDS ONLY: g
ergs• ectionControlPro r
16 Mail Service Center,Raleigh,NC 2.76991636
1, p�13a.Yield(gpm) ( Method of test 1-1 t s
I i r' 24e.For Waters Supply&Infection Wells: In addition to sending the:
the address(es) itbove,!also submit one copy of this form within 30 c
q
13b Disinfection type: Amount .) completion of well construction to the county health department of the
I'' whereconstructed i '