GW1--05819_Well Construction - GW1_20241001

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Parcel Identification No (PI\) I Hardened drive shoe.
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5b.Latitude and lonaitude in degrees mioutes/seconds or decimal degrees: i
22.(er title o
--- 78. (.113(iC4-7 w
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6.isi are i the oelltsie Permanent or 0 remporars Sign. ra nir crlificti;Ad{(sontractia
fit ,ivfliiry dui tura,.I hervh; ..•rtfn that flit se 0.11,1) I.I.,,t,..,.....,,,,:n..., ..' - .., -.„.."-....,
5„tfil ii..1.1r.-It'tt:( WW1 St I,I '.‘'If 0:( ft:int',I'd,, .,,,,,,,,,ft ,,...n.'.•'• .--
-. Is this a repair to an esisting well: OVes or E2 No
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anal r :'. ,•.17).11,1.1 1),,I...m.4.w!the ha.i ii;dn.I.inn
23.Site diagram or additional well details:
You mal. MSC TN:b3Ck Of this pale to Novick additional welt tote dinai:,or ...61
....for(;eoprobe,DPI.or Closed-Loop Geothermal W elk it the same
construction deuils You irta also attach additional paves if nect-ssars
„ • i.-.....ii1 iiii ,,r:". 1 GW-I vs needed indicate roTA I.NUMBER of%ells
St BMITT11.INSTRt CTiONS
9 I ntaI...di depth hafts land surface: SOS (ft) 24a. For MI Wells: Submit this form 1....1thin 31' i24,.. o':i.iontrietee .....111
• . , .. , •:,..•..i.r f•• ,..6.*:,..-e tit ieTampie- 1 ce:tt9-and:0 ItHl) conrimehon to the fidlim nig
M.SUATTC satyr Irt.el hems top of easing: (ft.) Division of Mater Resource..Information Pruees.akt I nit
1617%tail See%ite t enter.Rateitth.‘t. 21-16I-
I I /1,,reimIr diameter:6 (in.) 24h. For Injection W ells: III.i..!J a nai to...IJ..1i 1Li e i..iii i.ii 'ii,: ,.....i i......
i 2 ',..s rtl imnstruit him method: 7-40 t(4(1 abose also submit one cors of this TOOM tAI:i'lit t ...it.•t ..., a.....1., ..t....'
con-arta:awn to the hithmiiti
16%i%i%%%I of 1%ister Re...metes,1 thltrylaultd tuktitailia i itintrul l'iwzramth,
I(atit V4 ,i 1114`11 Pi'Lli W1.11.1.`s()NIA: 1636 SIMI Smite(ettlet,kiit•Ret.\( ',...-terT-,ink,
Blow
1 iit St irld tigpui, 1_5 Method of test:. 24e. tuo%girl Suitft4 4.1 titiertion W ells: ...s.,:c...: ,4,the karat 1,,,,,
lib the ..n.I. ..4.-.1 silo., al A` ,l''..,, 01 ia. ,Ot.N ori taw Wan *mem 4.0 jay* 01
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!caned 2-22-Mt