GW1-2022-07978_Well Construction - GW1_20220826

ors,eox�IIcriox _ -
GW-I
L WeII Co etoriafo -� _ For3�malUse ORlyvf 1\ �•
00 ft- zn V'� ms�ncox'
g
NC WeIlCo�em �
�P�'2'F�e ' 7\-• E7tOM TO D �..•rsvn •..
�aCHCoPe=m� : w:L zo123 3 - � $ �o � _ •� A.�- -:
�C�sssa$var;�ae) •�• � ? � SDze��� 's"•�reL"
To
3.Welltlse(ehmkwa mer _ rc�
p1A m wen. .�. .. :$; _,•••t-y_;�,,;w, ,.":�::ri, .
p � Ta arenffi�
Gg1 $ _
p 0?�°P/C°o1mSSsPPIY) d�tialWa�r�1�Y(�e) epSa m.
eILs 1 Opp �PPIYC�� .IS:.GRl7CL•�.: _ •�_�..,.:• ••_• •..
❑W > ._. -rri: .tiv=s_.r• _•'may�''•_"v'} ..
Noa-WiterSaPP19WdL CtPD rxnu zo •may f arwc�rronraeonxr
pManttonng•Inj a ❑Recovety
- ectio WeII: $ � �
• •Icy a
pAqutferRe chmp 13Gmundw2tcrR $
pse ft ys=k, �a�.�as
MA cfff=Test xieoas TO MAMMAL �m�tra�en
pS�'�etDtaarage $ �
amalTecbnology .pSnbsideax Codnl
" Comd(CloaedLoop) pTracer •ZO.�DBILL1NGr�` sl4eha"'afiib�aLsbe`sb�i£_" :�`•��: ' _ .'+•
G0° tgRettm) ❑Othrr(explamuada#21Rra�s) rsons To ampnm
_•
4.Data Wells)Compleetad: d ,/ 7- 1-21 Wenmg - -
5 WenLo�ition:- .
►-, . S l w
F,�ayiow=x=C FaaT:tyIDZ(fapp5nble) $ U .
�..1 Ir Y"� .2LTt1<67ABHS-• � •v� �• �_-•. .. .�=a: q^.�°
• PmcrJId=dG=donNa(PTN)
Sb.Latitude aaa loitade is degees/mimn�es/seco or deemzal degrees: A U 5 2 I; ML
(�weIlSeid.aaohdloagisso ) �
7
, 27.CertifrcaSon: ! ' ; 4 ura
6 Nam)the wdks): DPertaanent .ror pTenPoy �/ 0 � Sigma of � �•2 L
1 _ t Dme
8yai 'Td'fora�,I wW,)�Cave)co+aat�dmacswr7�oe,.�rl,
� harLYwslJj'fLa<shc
7_IstSisangmrtosaeaiftwell:- ayes or Wo LldX COZCA1oo L'EAN 1COZCAMOOTeZC.pmararmarSaaidm&anddmacv
IfthtrSaag.ab;�IIaabmrn � +and�TQbrlTie�a�azof77nr+eamdf+arLepipgwidrdmtJu' oara� My
'repctrrmdar�Ml revr�sarlaaoran�ltebarxofrldrfa�at _ ,�
23.Sift diagram or:dadoaal wen detaIIs .
8.For Geopmbe/DPT or Closed Loop Geothermal WeUs baviogtha same Yaa may ase the back ofthis pake to pmtide addaibnd wdl ewshudknm& -
00mirsucftca.G31Y1 GW-I m,mwded.IadicdteTOTALNMdBEELcfvelh (add'Seeove in2eni cisBo4Youmayaboattachadditcalpagesifnecessy.,
dtiIIed: ..
24.SIISM=AL INbTBUCJ ONS
9 TotalweD depth belowlndsurface: .
Formrdrrptsrzrmrazr&I if4b,wCea�ptg 200 dMgl0a7 (� imtflhGW-1 30dapsofweRcompletioa per the fou0mh .
10.Stalk waterkvd blow top of easuw '?tia.For An Wellm Otfg"m21 fomn to Divisim-of Water Reswaaes(DWR).
jf lodis�owe j�+' ( ) 1fatiomPmces m9Unx�16I7215C Ralmg%NC27699-16i7
1L Borehoh de:meter: (m,) 24b.Foi Iniedion WeIIx Copy to DWR,Uadesgto�d Inlecdoa Cm ttd(![1C)
�iD$�,1�M3C,Ra1ei�NC27699-1636 .,
11 Wel eonshmedon method:
(Lam;mmta9 cab%dautpm%M) 29c.ForWaterSan Ip�yandOpen-Ikon Geothermal$ebrnVensCepytothe
''. . oomty ft=aeoW neatmaepmfineat comsly m�a�e
FOR WATERSZIPPLY WETI S ONLY: Z4d For Water Wft do- over I GPD:CONID-DW CCFWA
13a.Yteld(gpm) .Methodoftest PeszaztPto�,1I1MSC, C 1Il
13b.M*ficdon type: Amok.
Pam GW-I' Nonfi CacoTma Depac�t ofFsv�ta�tal Qmlitj'-Divmoa of WaaxResamoes
Rwixd6.6-2018