GW1--02070_Well Construction - GW1_20240405

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WELL CONSTRUCTION RECORD(GW-1) Bar Internal Use Only: .
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I.Well Contrador Infornintlinu
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WollCo-o-iactor Name , - ---•—— -atom- -"ro nucentetion .( .
145.S L7 4-7 4 , IL O.
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NC Wen CootractoiCer I
.IAII3TERCASIPIVrarlifda.kachtlaingb)ORLINItikaf lr*, :...;-. '-. •
isii4iciao veil •b ViAiyiP }Wk. TO MOW' _I THICLTIT.S11 mama,—
IL Icn IL 63. i !
COMPanikiMe . *• F.3- '31kIci&-TAk•WORIVEZMG( therrirafilacermirors)
Z Welt ConstructioriPanitk I q 15(5 rlaqM _ TO maw= Imam= num&.illt oft applicohlrbodbannancdcapansiSi fie:Ulermoirs.:tia ea ilititce.nta) — rt., .ft.
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3.Well Use(checkwell%ISO: ft. ft. fr. , ..-
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Water Supply Weil: TMInenrageffi,-..-...?.:. ::::_•-.. ,7.-;.•••:, , ;-,..:, ...5,;s:-..-..,.: . ,.....,,....
, masseuse• -ssicirscri =crams '_aorraniar."-. •
Ili Agricultetal ?duaieipaVPobfre gt, , . Ii•• 1'
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ift Geothermal flleatineCooling Supply) Sitesithiltial WaterSuPply(single) It. a' IL -
induftriallOcannereid DResideadal WaterSupplyfsbared) :: •-:--- --,--,--:•,-, :.• -.••.._: •-- .„.. —
-nation . snow .,TO PLYETROL ' . EISOLUNamc-f RIM. HOD&A.MOTICT •'Noir-Water Sandy Writ: . - - - • - 0 gt, 2O it iohrt ii9filiAt)
IN Monitoring 011ecovery tr. U.
blikestionWells - - — rt, a.., ., „..=,.,..1
111.AqdferRooliarge riGroondstaterRanatiation
::„IsatarentravimiiiittatriMilserteer•-.•-,=.'•;-.., -....i..• -.--" -.-.-. ...•.: - -
01 -, 1-Storage and Recovery E3Safroityl3anier sum -TO 11LTEIOAL einureini.-rAtiinoo
.lii AquiforTe# riStientwatertkainage,....
in EvarixasenteTecimology riSolafniameContic4 '
i Geothermal(Closed Loop) Cilium -my, .fttailiktdiiin 's - iia!unaiiiiibiati n '•'' :-...,•,-: •••f: •••:: .
' *Goolbertnal aralabecoortag Rolumk, : Ottra(aylauodar#21 Irsardts) ' IR°31 ft. "
4.Date Well(s)Completed: Wain*
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Cç'Ift
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5a.Wen Location; 615E'--i IL . co' /\1' 1?D Gbi-
I<61 15 OU 1c1Q-6 -143c re- it_ 5 6- J.Q.; CI rat' ;tit, ' •
C I I, L\IA A k-tt It. ft. , r...7
Ito-alcal Addrar;eity,andrm. ft,. IL
•-:-;;'',: :•:*:7,,A fR,:-.--617.•.2.674
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PAre5aCcamcatioitifo.0.4 -- _
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5b.Latitride and longitude indemteethrinutesiseccodsordecintaldagrers: . •- • "'' -
°foe Zdd,ens Womb antficiers) I
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Sc,CPC/6P0 N V..Z.,31Y3
Sktrotaro ofCcrtifiertWell Contractor Date
6.Is(ext)thrwell(s)114Permantnt or Effemporary I
By Aping Mit_Pm I Infreby me that the WO)was(were)conconcted In accordance
7.With a repairto an cdsting war. Dyes or 12INo with 254 Mc 0 7 C.0100 or 154 MC WC-WOO ffill Contraction*aeon*and that a
Lillis Is a nricirdinaat klaxon&cansancdratiVonaoSonord&Vont?e naive cl"the off°IV*nmonfbarbeess.cmide go Aiwa CIO=
rd1h7lit martin reintriasectianorat ihe&lacier's/am •
23,Site rfragram or additional wdldetansi .
S.For Geoprobe/DIT or Closed.Loon Geothermal Wells havingthe same Ira°smsY.use 1h°,b1414 c"14 puke 1°Ftevi4eedditleesi s_teli site details cc wen
coostmcb co dotal&You may also attach adpmoal papsenecessary. -
coostructioo.°idyl .6:17/4 is needed.IndicaMTOTALNUMBER dwells
drilled: sum[17.1 -INPINCTRIV
9.Total me depth below landsurface1.9 ____(&) 24a.is*04/11§,_... Submit this fowl within 30 days of completion of well
Farnaddplevadhltst all deinhspirerent(consple402(09'and2e3,11047) cOnAroctiantOlharallau14 • .
10.Stattlestator level Mow top of ensinm .L lid0 04 Dhislon of WAtcr Rommel,Information Procceshg Unit,
"water kvel isobar e casing we**1 mi 1617 Ian Service Omter,Raleigh,DIC 2'7699-1617
XL Borehole ammeter. (9 /5 _(ln) 24b.For .,.1"!k'' In addition to sending the form bottle address in 24a
:Move,also submit one copy of this form within 30 days of completion of well
12.Wen constructionmethork_ 4f: ieffe.A.T _ ........Intim fbilming:
(i.e.sum rotary,cable,&reap*ere.i — I,
Didii0O of WaterResturces,Underground Injection Onttrol Program,
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iiiiiiA WiWitis max; 1636104 SariceCatter,Italtigh,liC27699-2636 •
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ir.fiddtgem) 7 I) . metbodortesu A.iy-.1 iF 14c.ELI..,,L.l'ItcrAttpi„et itriegion In Waikato swan the form to
' 47--/;/•7- .v the addresges)Above,also!Omit one=prof this form within 30 days of
13h.INnfediontypc Chittri 1 t '4--
'1.,. completion of well construction to the county health department of the county
si C., Atormarb 7
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