_Well Construction - GW1_20230327 (86)

•
Feb 161905:43p ClealweterWellDrilling 828-62 7241 p.t
WELLL COiNSSTRUCTION RECORD{GW-11 For Internal Use Only: -
I.Well Contnwtor •
Information:
Mtr-k ,
/A 14 WA't'I$tEONBS
Well ConttadoeNaalr moss •ro Ott atrr+oN
32?LQ -4 tR Al- aft. .
VC NrellGnntraetort.'at1$erdaa Mailer
C1 Ica �- W t✓1,1 -On lt:ncl TITER l+��c�r p
campmcylrnay
1 �� ��^'�- Ian
x.Well C t 2 ..020.
}6.WNER OR
�p.tt�onwt s�a-f Ve,
-
oalt raclfoa Perlmlt#:-- � °PO 4 i;: DMInraa TA wtt�ptar.
Mt� niketble wait catrustalan pima?OA I/IC CUTAij;Sla1c Varf cid.. L. g.-4 ih.
3.Wdf the Wirth well use): •
n: �� in
WaterSappb.Well: 'g.ortitilbile
A 3 t:itt:nl OMatidpal/Publlc • swarm t marmot Totet:ree= , immutp t.-
31 Geothermal(11eatIng/ConlingSupply) tRisidattiat Wator Supply(single) ra - f !s. sa.
X Industrial/Com:naiad DRe sidentisi Water Supply(shared) -
*irrigation &(1011f
Mom To ibtxtuneo. atAtMA tailors antosamew
d njeeelon Wail:
It Aquifer R rmmdwotcr 1�
+Aquifer&brag and ry Battier lsctn¢diatinn froom SA[+�ICI tot8L 1►hQ[KA..' 1. wcsttuvrmdhgtttoo
1i AquiftiTeet a. �jjA4tt�7►►�r..
II TxperimemM Technology �.Subsidene a Comm!ge
it. it.
•Geothermal(Closed Loop) prom i V&DI11L IIAC(eelhmi�ie eRttuedrtstt� 1
' Geothermal(Head» opgn Rehm) 'l'Otbea'(oxPlain under#21 Remarks) 1 - San
((m_ ��fii r-i- �atsb'woolly
tr. a. �LAA 1 1
d,Dam Well(s)Corn meted:2 Z—23 wen ID# _ I g it '1 D( f, ran\ten
So.Well Lamella: Uli l 1#a,V-e n t40Mes 1b1 r`. 10 Zit' .
i` ylevaterName . 6 gy104(ifdpplitaLle) 0
It. r. . ` 4a , . . �F ` . .i: a,.•
Ca�n�heu fir. R ti � r°5
ii Physical Address,try;and Zip - Th. r-
_Lt 15 I „al.AZMAR1tS ' ,-2z
°my Parcel ldomillcation Wm( IN) r,,
Sb.Latitude and to>t tede ladtgreteslmimttesfsecandsordecimal deg2. dinar L.,
rees:Orwell field.one latllrngisendnalerul
w Oaf
s.1s(arc)the wNl(s Pea�rtaturtt or alrempurny Si ofCentliintwell
I.to this*repair In no By aignIne ehh form I he:n.50cme'4y Oat the wcLr j Kw tirdv)antat In acoOMerce
7.lethis*repairIn misting nits or JNo rah lSiIliaC'D2C_QIODarISANCACWC.I1100attlCwsvrrearonStmear�amfdew.e
,OVA* repah il'm°' 001 nsalfanondcspfai t i e Immure(tribe 1oA.V+4110:11'eotrl h4cbrxp prff61�d h'i rl a well awtr-:
' +s*saokeordehlatbrkdibblee:a.
8 For G x.L.Site diagram or additioaad weedettses:
mirolaMPT or Closed-Limp Geothermal Wells backs the same You may use the book of this page to provide additional well Sits details or well
:mhav►nusien.only I GW-1 is needed. fndiraluTOTALNUMBERnfwclis construction details. You'ray also attachadtd1
rinlled• _ additional pages if rteeessery
ry,ratar,ogl do §iJU JTrAL IP TRVCrJONS
depth below land=then Ear An W21
Faraahlplcwellellttalidr �� (�'�)
r+n.+Ialmevnr(e:axpla.3�sa0 oud;rdflewry Welly Submit this faint tiallldn 30 days of completion of well
It Stolle*aahrlevd b _ canamtctian to the following:.
aiow top of (t)
Meths. itFnrsc toe•``'.^^ t op.
Division otfJYatet Resources.ltafht9aaHora Promoting potion
t i.�ttebntedia»tetet: p 1617144 Santee Center;Raleigh.NC�17(clly-1617
�r�{in.) 24b.Nor ralct;tton Walls: In addition to sending i2,Well construction methods r v'! eimve also submit onethe Foam to the address in TAa
(t e.auger minty.eablo,Coat SPY of this form width 30 tee)ra of oomliatlttta of well
posh,eta) • -• c anual=to the following .
•
DIvia on or Water Reamltloah Underground JflJ lJoa Control Program,
FOR WATER RLPPLV WELLS ONLY:
(lie/
�y 16361Nai1 Service Corm•,ilaleigh.NC29694-t6a6
13a.Yield tt ul Waled of te= (l,e/ 24c.Rehr Water Sonde&infection Weld In addition to sending Ike form to
tab.Disinfection lyp Antolini: Ibo address(es) above, also submit tmc copy of this faun within 30 days of
ha a construcpletion of ten ed. eansteucdoo to the county health deowi neat of the county
I
Arm C;W-1
Muth Caridice Dammam OFEnv►rtiktlinnd Quality-1kNmnn ofWattrl�anamcac
—._ Revinca2-22.2otb

Wen Driller Set nut C.rdtklon
Qxoucn o¼.ie(l on
awn c:_J 1V Well:
Address; ULU) ecimpbell 0r R ah;
I hereby certify that the above referenced well was grouted in appearance in accordance with
all County Well des.
well Driller:
cerfftcate#: 37-S(4 -A couIed: 7--1--2
Construed= Gent:
Total De th._l 45- Type: �� \�
Casing 7v C Thirlaness: .(Yl\cULL
Depth:Casing IS Depth;
Dlar ,r, t1
Weightfiltdc
Drive shoe: