GW1--01806_Well Construction - GW1_20240320

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l:of irdental Ilse ONLY:
Ibis form can be teed for singe or multiple wets !
S.Weil Contractor Information: `i f
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Rex iMeedows
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FRONT__T70 __- rJt V2ilIPTiDY'
Well Contractor Name ti. it. yII
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NC\Yell Con or CeTtificalion Number IS.OUTM cAslNG obi:fault!-eaa,_-:dwellsj:l1t1.€.4ETi(if api1{ iblei
CIeai.�rwter Well Drilling inc. I j n. 1 u 1 ft. I I�Ji lhi. 1 1 gi—ei _
i_p:Tr..nt-A_•7.1m ) 14.iii:vc:'.2 CAFLNAS C.R.I:.r.IINC-fii£:ut a faaII,. •-1oo2 '
t Fi?,'?ny "ro d rt:t,•1F.7ER.--t--Tfilt' .'rS.'3 33,:TFRIF.7.
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List all applicable well construction permits(t.e.Cotmo%State.Parlance,etc.) i 1
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Its SL.li-r L`•r`t.•TF.�.Welt _ _ .-�.. 1•_1� ! I� CY1 1 U t( _ � _('_...
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Fee t?ealar 't�roeLt }�-Yrt live'----.
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I nEc a itnental lc ttt}Cieg. 2'<::_ :f.e.Conttol li-__.1 -.--_t _--
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MAR 2 0 2GZ4 ._
• Physical Address,City.and Zip '.... -. - - _..-. - -
Infouri.suon
Cv ot) _............._:t:....No. t s-
511.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 rertificatitlr.:
(if well field,one lat/long is sufficient)
. 2 1-1 1 1-7 w 2.,........____ L.....___________ 7 D---,D-I- 'Lt
„Igtunt:.ni Ce zd:':11Ycll Cor.fr.:a: Dale
6.Is{m-a)the weli(s): ermancnt or ^a emporary By signing this jinni.I hereby magi.that:the t ell(s)was(were)constructed in accordance
filth 134:Y(AG L_i:.ofouor 15a:YC,',COi'C"mot);letiagruructiar,Standarde and limit a
i.is'iilis a•repair to an existing%veil: Olio or i'io copy of lbis record has been provi kd to the till owner.
if tidy pi tr repair.fill sett kas n'a 1:nl?.-[:r_:1 ar rivr i!jcrtnatia•:Ind aplail the ceiaire.:1;h'r
repair under till retnerks scrtion or on the hack af this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
g-Number or went.cgnetrnetect,_ construction dcm:ia. You May who a adi addilive ti pag_e5 7 i eer.r.S_.,Tr.
For otultiple injection or nun-nztter supply yells ONLY with the same(oasrructlen.you can I
stJnair,ore biol. :Sabi:biz ii AL 3:,•113d -C.i:^1:4l; f
..•.•cdat wont dcg;ti,t ;:sr i'nd ci;rfar•e: �Q 3IL? 24a. rpr mill')).'ells; Submit this forma within 0 days of corns_letiou of well
}. nar.. b,.,I,,o)h+,;;e!?.S,- ,r 93 n.rr .8 -,,,t t..Ln...h,t..i:.•tgl-nrfi.'#: i(f`1 -.---� tonsil miue.to fire iOiiftiiu}v.
top ) C;: .i�c'°' .. '._..j•,_ : °----r .;'.-.t;:
t t.ysn.tc�vaacr]cre.tretnry 6 I est. ;�•�.,L. i--t .._ , .
Ifnvier lt•vel is above casing.use"-v' 1 lee e a;jai:,,rev crl;i•:'Cr,'t-'-s:lrtdt;N; >"eti:
Im z..._j._e- __.-_.._. i t/\1 t5-1 `-+,aA t:nr In1:;sir._"s4._1.lEzz ^..?:F:rvj`re.rend 1_e to?:-r- us t=v 2=sirs,^ira?:i.
.._...:..>-..:=_..�r.n-_ sal- •- _ _ �_ �_.. _. ...._.: ?
._ above also submit n copy of this form within -u cave o;c ir..pictin:1 of well
i 2,Well cis-Strad.rj-mciftti£i: r .i(/L "At/ _ _,-•_-_ _______ .Gust." :iO}::U the tolto :ivtg•'.
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•
Wall Driller SsWeir.*Cordatatten •
owner: aaL0‘,..s..-2a4e(-- NewWelk_ V
ildthyss: tqz Repair: I
pan% reu-rnsvi 11.e. C
rhereby awilfylbst the above refeeenced weBa glowed in appearance ID with
all County Well ndes.
well Driller. Re)( eact oLo° Rine&
catficale#: 81%3 - A- Dato Quilted: - I
Umbras:do= Grout
Total Depth; ? Q Typ= aernex-IA--
C.asing Type: SA-e e.( Thickness: rn 0.1 6
Casing Depth: Le Deptbz b -
Dameler: LP-'Ns •
Height
Drive Shoe:
GPM: 5