GW1--05861_Well Construction - GW1_20241001

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WELL COMMIX ON RECORD ON FaTintereThalrgartili-------'
IL Well Contractor Znformatica r
David Belcher — -
L1fo1l contractor Samo IlETWAIrfi�4l1DliTt
MIME TO -- :atwatCt
46944
NC�VoltCctthaetor2eetltteationhS„ - 1�+ ae
mbar qt. St
41�DM,inc.
us LUITRROASEVO tor tnettlegiiiilw ile-tr3R LINER .CompanyNeme r® Du MR e..p.:••
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��We6i Conset'taettoaa Permit � .:e� 'L' , ` i't ,4 i t'v%':
m : Ct� 16.E BR CASINGCRTI➢ otberarbalelated•labo?
List all applicable well caus'tracllae permits isr e.WC,Coning State,Klemm eta) -—'""'
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1 Weil Use Qebeci¢wall use): ___.�. t° E�' a"
Water SupplyWed:
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Agrieuiturai �� na SCREEN
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Geothermal(lieadng/aroolin g waicipaWubl€e t a® eatispa a 011.07stas «
S nppi�) Residential Vfllateir Gfft 6. 1 n. T 16�`MUM -
Geothenualamtnercia4 .ugpiy(single) it.
- 5a _�rri anonResidential Water Supply(shared) .:.,�,a—.. �.,s,=.,,,il.1—@ktion-Water Supply Well: g. ''�
lifenitoring �. P�A�EM19�NT'tVt� 9(DD A DUIIfTrt Olen ell: IBe:overy t¢o p� ,, �t r. ie�
' Aquifer Resite ge
Aquifer Storage 1�dcndw®ter4temer➢uatinn ft. e.
8e and Recovery Salini t91 r ;.
Aquifer Feet Sander
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a StorrtnwaterDrainage ° am �, ," = utwPZACetH¢m7vJe ,:e,
,Experimental Technology i A
Geothermal(Closed Loop)
�Suibsidenc®�®nttati y=
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Geothermal cad IroolInr'raeer
in,RODILIIMG11.213 iateicadtikiiiaata— Maness
Return) ,, , (Morten leimunderdi%lulu) Emil - -- � °5Llcall`➢_lt7Ft Samna"lika he. 4 etie.ate.4.1AateWeifl(s)Casaitletedo j5�e. ,f
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So.WO Imeatilent
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Pao ()war likras
' 1l' FacilityMetit'applicaele) tt. ,+ ft. .. _
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Physical Cr �1 E' aC+}au W" ����
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t Address,City,and Zip � _ __
County Sli lAZlirlA�3i
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Parcel 1dentit]cstlan No P
t m.. :..W., r•6
Sb.Latitude a 6d 90 asgaeeskoloasees✓szeouda or staggered&grreat
bag is sufficient)
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�h,d6 R� � .—ram-. �.
� D tits wiell(s) ?Imam
�etu9tiiroe y dig tune ofertitied Well*matador .' — Dale
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accariltinee
a.lip This a repair to on
phis a vopaJv,jJJI omicron �s �� or o By signing thisilet a,p hereby cer�that the well(s)s wax
:uft of eUC'AC�IIZ .WOA ar vi dtoNei t°l we,'.�inner. nsdvttcaa9a Standee.and that a
repair ender tAbn alma*sa wr`�amemease explain the now a'the
,f copy afPhiss•arastlu3riarbe�uprauldeaPtaaYte:ve,Plawner.
�01f®e�e®giam�ai➢81�71'®�cCles a Stte d __ma or adelllo call wellfl deals.'
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snnatr 42F:y calif i Indicate h^�Weila having the sane You:my use the snack of a is stage co g nvide additional well site details or well
Inha uctu if, `l in tie
TOM,I1T6F1Ud[i)(R off:weaps can tritLttarra rtaiEs. Yea fiiay al�u e+'rtb eh Additional pages lfneegssargr,
:1 Toted well depeit been Vawd ana sae: -� (�t t�lonHTi_r llt�u mlrm .rewattillple we&llsr arlldepre:O ffarebet s �lfft D
(example- P4©.Nor AIM wag. Submit ibis fan Wviehin 30 mays of zsomltleaioa of well
Il®Stele Walk**ievell Wow 30�sr casing: �f G cans�ra tlon to die:folltswmg:
3.6).ifIll tt ele W a k**ht1,1 t a)BJ7t,tw top .„ _ .-,.-.. .a) Blvlsllont aft Wager i&centeea a,i Ee:maa4iana RN:waning lak
i I.ltlto3e!;,,,lra r: fn )l6ri`o'Maervsse Candor,l@atlelgle,NC t9�9-Il�nE W
QtwoD
Ili,Well cgtneevie,4ieyD mamas Ale.Sop Rtbii.2_n e��s Iln addition- sending Ste forth to le address in 24a
el
(i.e.&user,rotary,gable,direct ' above,Also same one 0
push,gip,) .,..-__---�.,......, _. aynstruedan ar9Im Mowing: of his aoran,vu theea 0 nays of ea t>ly9tatioib of aveli'
lIDfiviaka wtl'YUcatarP
n�m, i ��D �� nf15E /aNttta,a�b ]l1t e
- . PVIIei;r�mfi'tteat: � � '( WC
Dyh. +'� �'9e,CQi V!vt&t°�euatgLcv .�,al®t 7n addition tp F
IDlsBnfec�ebat ty ;mot the a thess(es) above, also submit cute Atedays .as
Al usoe:__ completieu ere'well constrotok rb au the nent a al days of
where a:60EeaT EletCt�„ o the count!,
Form OW.4