GW1--03265_Well Construction - GW1_20230511

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Feb 1519 05:43p CleatwalerWell Drilling .............�....
WELL COTi.^1Buc�TiiON RECORD{GVV 1) For internal Use
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c Pi 9 a- in.' fee(
C4mpaayWdupa — 77 �l6.�1t+iNCR -1 OR r.. r' .dootwl .'._v: -
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2.WM Coastrar 'ioo remit fi: C Sll S ft.` Et • in.all applicable we,ennearraknp rtmlft(!a INC COThwit sine-rarlmtcc,cut) ,
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3.Well Its(cheek well use): i-
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Sappily Well: molts• TO maser ttltDrat= Inamettela atemetAL
A$ricukural flMunicipaVPubl(c q 11 a. IL
Geothermal(Heating/Coaling Supply) Rtdhtential Water Supply(single) ft. ft. to.
Industrial/Commercial esidetuiai Water Supply(shared) is oiou • iltvnaatn� �utte> rnri a<Arrettln
Irrigation _ Q
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ft^ fl l* ril`a
Non-WaterSupplyWdl.
Monitoring °Recovery O.
njectlaa 1NcA: a. R. �'
AquiferRedaargc Qtiroundvsetcrltctacdiatitm S.SAND/GRAVEL PACK am G i LA ortlttoo
Aquifer Storage andRccovaiy �aii»ityBarrier aeonTn �.
AquiferTtst E35nmtnwaterDrainef IL a.
Experimental TeelMology °Subsidence Control ��o�.WILING
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Geothermal(Closed Loop) °Teaca au WI LI'GLOG MI6._,};,,._ !t'i't•_ ae�1
Geothermal(Heating/Cooling Renim) r3Otherfexplahl under 921 Rcmatks) l ft. 'i '7 R 1/,•' 1C.
Well IDS/ h' ftft.
4.Date:wdl(.)Completed: - ,, t
ty •
Sit.
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IracflayrOvmv bans _ EseOhy rtw(ifgrplicabtc) t.+ f g
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HO its .rS DO ,mac to(i1 ,2I.REMARKS ,t P,'( '#
Carry • kraal idamiIIation No.(PEN) �� ' ,. J,.,j Urn&
SO.Latitude and114 v''� C.2r brrgitade in d�leeslmatmtes/secaleds or decimal degrees: •. •-- .� rya.,,,.,
(Jewell field.one Wangis ewnefcnt) . r O( 5`� I n 22. lion: 7
14
iv OWL .v . 3 -g-1 d3
6.b(itre)Me wdl(s)14Pmmanent or Qflemlporrry si Ia[rco1Cerltr d wall tractor past
sty Annum+thaVoan.I herehy ramp that the WIN war Awe)eels eetedJa accotarerce
7.ls Side a repair to sac lingwdh rfrcs or No with IS :rY.1AC112C_flOOorISA,YCACO2C.OWOWellCons/ructien 3Yeek,dc and thin a
lidita Lyn tepatttfillowletewnwdiaOnstrnumai frrescltoamrr esphdath taimunfthe e°PY ilitixa ahvbee►tPmi'l*ltothgwdJnwnat:
tomb under d2i rvenufn sixths?armere back afthkram.. 23.$ifs diagram or addltlonal well desalts:
S.For GeoproteclPTor Closed-Lonp Geothermal Wens having**seam lion may use the bock of this page to provide additional well site dctaila or well
txnmlmcNan,only I OW-I is needed. helium TOTAL NUMBER al-walls cootruclinn details. You may also attach additional pages ifne eaaaty.
drilled•
.. {rpn EIDIM TI'AL IPit}�'Rilt ITON§I
9'11'ttlal well depth below land surface: W D Phi z� War Al, Weis: Submit this form within 30 days of completive of well
'Meawtopteweueusratldepil&U ej( Div-3@JOR•mtd."Qdloai construction to the following:-
I0.Static water level below top of easing: •-• (fi) Division of Water Resents,Information Processing Unit,
?limier ford Is Am e at dng toe ^ i 1617 Mod Service Center,Ratlfgh,NC276 9-I6f7
Ii.Borehole diameter. (0 I 0 1(iyn.)n V1 24b.Nor iateet Wean In addition to sending the form to the address in Zia
12.Well construction method: i V 1(�tl U1 above,also submit one copy of this form within 30 days of ttomplerime of Well
(i e.(rage-,fenny.cable.threat push,etc.) CIblSllttCltOn to the following
Division ofWater Genevans,Undergronnd.lnleetion Control Program.
Pt*WATER SIMPLY WEi J 9 ONLY: ,� 1636 Mail Service Center,Raleigh,NC 27014636
I 1I(/�
Yield(gm) 3 Method or test: W' q me.F -Wider Sandie&II en Weft: lit addition to sending the form to
rim addresses) above, also submit sac copy of this teem whhi»30 days of
tab.Disinfection type: Anima completion of well construction to the county health akpatenett of the county
• where consteucted.
•
rem GW.I WA csrtilianGopnr/mantofthwhitaih@acd quality.Division of Water Reeturees Revisd2-22•I0i6