GW1--03295_Well Construction - GW1_20230512

828-622 7241 • p.1
Feb 16 I606:g3p CleatwalerWeillDrtiling
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WELL CONSTRUCTION RECORD(GW-11 Fnr Internal Use •
1.W.IP(Mntradar in n: ____________7_____ _ -
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WellCenurachaNatne (6
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VC Well CenbattesCatilioYlonNumbe I :R m G 1 1 n ., r_ '-.I'=
C \MOM0 \&kLb\n(( c- . / + ��
CnmpsnyWtmn 6.lIVNSR �., t_L3d:ls�
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2.Wei Cambodian pent#: ft. NM •
in.
List all applicable teal!cans►xpbp pandit u IJIC Gnmty.Safe.Vartaiwu etc.) R. ft. in,
3.Well Ilse(cheek well us* "17
Water SrOtt Well: ins • me sera..: _ mow= . ►
mielpnVPubiic p �, at. is.
Geothermal pleating/Cotling Supply) Rif
Water Supply(slnple) ft. O. `e. .
Indusltial!Catonsuut] OW sidduia!Water Supply(shared) ram. ;I, R7N A Ate0tlMr
MATF9 e,L tdNA t•
irrigation \. R b ��� m AV
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Non-Woteer SupplyWail:
Monitoring cJReaovaty a. R. ..
Nation 1ATl: n- R
Aquiferiteelltilde Q(irouadwater Rcntcdialiun TO tfA t. �ttattwct'akitrr>dtYlltosa
1�Spi�VRL1'ACK1ifs0 )
AliuiferStotllgoandfteeily �5alidutyBeaia Sum
n D-
AqulferTast riStotmwarct Drainage _
tixperimental Technology DRubs]deneo Control f ft.
Geothermal posed Loop) Erma MULLING rA
LOClrihob_'�p lu{ i g at tette..►y 1
Geothermal(HcatinfiCaolin*Ream) (eRPlaln undw 021 Remarks) • , ft, OW tx 8(a �/� - r Jn 1
4.tlateWdl(a) : �g Wel 11(AxA . .. 'aw 54D n '-`r'�
isi
Well Locations Ala 'w IV'9 ' j
eri I Qn J .94 f►.WS& (ip le
Faciity''tkm Name •, Facility(Did(ifapplicable) A. ft. •
1 1 tr. •
Physical
Afton,t' 1 My,and Zip R rt.� lY _-4. y�y�a 4�—' ,
Ma iri ,..A.MA �
Camay Parcel ldo nMcntion No.(PIN) ,.. - / 1 v ZOZ3
lb.Latitude awl tonAltude in degrees/minutes/seconds or clefts!degrees: ' . - ,,,,, ;4 Lk A
(ir'aonfield.one te_tllonsineutile1cnt) r2,Cerfilication: In¢a,,:F{;";:#L i `�
3S' �S1.D 14 1 N �Alto' La.613 w �� ,
&ls(ats)the wtII(e) PAwatxM or j(Pempnr'sry silpa oftknifird WclICmrtractar Dare
It nitres►hut.farm.I hereby omnJp that Our mdt(9 war(*mu)eawnracd us acme t+rree
7.ftillsa repair toanexistiogwent Inns or ONG
with lSA.�iCi'02C.1)1OOor1JAXCACAWC.0100WetdCa+slencrsxrSYwami:antidwea
IfthkLcnrr,PairPIotelowswsweltstv+umcum►�omaireaopfuinlhr MUM erne t"PYofthtxtrcnrd/rotbroRrv►Y ilnMaw Mawr(maim
Moir under 12i ratmurlrx s vM,,wester deckahhh farm.
13.Site diagram or additional well dektib:
S.En GeaprorrelI PT or eso.edaLnr p Geothermal Wail baying the sane 1'ou may use Mc bock of this page to provide'Ninonal weld rite details ar wall
. aamahuctim.on y I GW.l le needed. radical TOTAL NUMBER of wolfs construction details. You may also attach additional pages ifuoceUaty.
drilled. ' n C� dliMJI]}1i,itt$1RUCrn,QP1S
9.1I'egt well depth below land surface: lJ� ✓ (il+/ 24a, For AN Wells: Submit this than within 30 days of completion or visit
Far nrhlpfewllsfvulldapflufe eatrezraapla-34110Craarnlai09, construction to the fa owing:_
10.glade water level below top of easing: (ft-) Division of Water Rewureed,Information Processikg Ualt,
u.water lard isnhrirecating,Me"'" I(� 1617 Moll Service Center,lReleIg6.NC27699-i6l7
mn
t.Borehole diameter: LQ (In.) - 24h.For foisednw Welln In addition to sending the bon to She address is 24a
- ro �/ (/) ,� above,abo submit ono copy of dais Ram within 30 days a completion of wall
12.Weil construction module ''0 "� copsttucdion to the fallowintc ,
(I e.nubs,Muady cable,direct push.etc.)
Division of Water Reeourees.Underground Infection Contra)Program.•
FOP WATER SIMPLY WEI r.S ONLY: 1036 Merit Service Center,Reim,NC 2769 -t636
13a.Yield(gym) I Method of test 144 { Me.Fgt.Water SPRAT&fnkctlan We : Muddition to sanding the(bum to
the auddtess(es) above, also submit One copy of ibis font within 30 days of
e3b.olainfeetlon typ . _ •A Muni: completion of.cell conttmcdon to tau comity health department of the county
• wimere commuted.
• I
Pm Cw.t Noah carotins Dammam nftnviritimi9nai Quality-Division of Water Renames 1 Revised2.22 MiG