HomeMy WebLinkAboutGW1-2022-03408_Well Construction - GW1_20220315 WELL fQN TRIMMON RECOL Gw x1 For�alUse o>zly:
L WeU Contractor Info dome
�rtaox h
WenC C'Gt law Rzor�s.
F80M To -'ir�ox•
ISO .3oD
Ncw�cN� fL sxoMU[EBCASiNG fm�"nmin`ened;:F>Es OR7�D;It r:._•_.
rest � �reL
�P®D'N®e R ft is
2 W,eHCo D6IIII�tBR'CA.SaiGORT�IIQG " staQmit w�;>.. ,�.._.;
asRvctloaPermftS:
(�c� raonc To
ZLsaaII app8�ile,.eII do per(R�L� Corday.snmc v�imr�eu� �. g fj R SD 7 �oaous ess�rs%
3.Weil'Use(eheeikwea user O i �' ►Z•
ffi
Water Supply Wel. �JS7-skim �. s;SkyyY•xa,>At�y J a. .a .✓
F80M
OAgricuhtaal 02+ftmieipai/Publi TO .; areaffi�is STOTsltE MATIItrAL
O fL is
GeothemId(Hea#*Coohag Suwy) Water Shy(fie)
MtW Water
fl on dls>100 000Y( �
Ow •IE'QtOITf�•' :r;r. sue,i i�':'a_�tr :::` k= '
N—o"i=rSapplyWeII: GPD FROM zo: iMAMMILL XMXwtZMMrrM=OD:.urouxr
qMMft=9 23 DR at r
e��
Injec6oa
oAquiferPteebatge ❑C=undwaterRemedie'm $ .
DAquifcr sndR-OVc(Y Dsdh;ryBCe= A9
FROM TO MAMMM Tyr. MtEffmD
OAquiirrTest OS�omzvraterDraivage >� 4L
Olbgm m181 Technology O uEddeoee Control
OGw&=al(Closed Loop) OTtaca :Zp,,DBILLIldGIA(` sltii]tia0ditia®iLsLrs"tiif j er. �.
OGeoffi smal @e-8NM .00liaBRenrm) OOther(atpl k=dcr#21 Remwb) FaoM
$ t
4.Dstz Wetl(s)Completed: �-!0 ,ZZ WeII ID# fL
Ss.Weil Lofation: k fL ft. !
Faa7ity/OwaecN®e FacftIDO(ifgVHcabie) $ , tL
7 y.. ti..
� Parcel SleauSaoioallo.(PBS '•`,` .ti. n Y" 4 3
Sb.Latitude and longitude in degreesemmnt wseconds or decimal degrees: MA R
(ifvnU field,one IWIM a �i) a _
3� .. 22.Certification:N b ) '
6 Xare)the Wws): ermaaent br OTemporary I Z T"� S eII Dme
7.b this are Casa > BydVdfsftfam4JA-by-nfyd—hew4s)was(&we)omarrr�dbrca�vd==v ,
pair temingwen:- oyes or mho 15AN=02C.0100-LUJVCtc02C.0200)rrffc „sWZIV*ffldZhMraMpy
lj isargalY,�IIori�m�rreIIomavuctlarbrJarmoslmeaadeprobrrheameosofrhe off+isas+madh=beoep vWdad:v*evrdamw.
.?qx&WxUrtrllaaamdss=ff=*ran rhebarkofzFz&fw= -
23.Site diagram or ad&donal well defti1r.
8.For Geoptobe/DPT or Qosed Loop Geothermal We&having the same You may we the back of this page to pro4ide addidoad well c=&ucd=hXo
conshtu.`ftM only 1 GW 1 is needed.3adic3te TOj'AL NUMBER ofweils (add'Sez Ovee in Rcmadm Box}YoumW also attach addiliond pages ifinewy,
daRed:
24.SUBMITTAL MMUMONS ,
9.Total well depth below Ind smftm. 3 2 0
Poi-=&PIC was AWaffege•y4be,aleamp9:-3@2po1md2@ZM () Submit this GW-I within 30 days of well completion per the followhW.
10.Static water level bdow top of eat 6,o 24a.For All Wells: Orig-mal fog to Division of Wafer Raswuees (DWR),
If+ teoattr�oWeaat '�ae�+-( ( ) btIM&MP=c=ingUnit,1617M5C.RaldSkXC27699-1617
1L Borehole diameter. I� {m,) 24b:Rol Infection Wellx Copy to DWR.Linde imuod]Weed&Comtol Mq
"� /� Pm$am.1636 MSC,Raleigh,NC 27699-1636
11 Wel contraction method:__l'S O�a — /•� ,—
(L,—-ion able,daeftynsh,�) 24c.For Water Suvpk and Open-Loop Geothermal Retorn Wells:Capyto the '
ootmtY eavommental health epaut Imes couoiya iaslm i-ed
FOR WATER SUPPLY WET.LS ONLY: M&For Water wilk do ' over 1 GPD:COPY tO.DW1%CCPCf7A
Permit hv8MM'.l 11 MSC,Role' C 1 11
]3a.Yield(Ypm) I D Method of test:
13b.D shfiction type: Amount:
FoursCrW-1' NoehCMDN=Dcpau=ofFavfim= di Quality-DivisionofWaarp= ar Revixd6fi2018