GW1--03297_Well Construction - GW1_20230512

WELL cONSSJRvcTIoN R oRD(ow--1l For Internal Liao Only:
1,Well Contractor lalllroalton:
\-ALt Y I ,U/Ln 14 WATITIOONES ' -
511e11CeahtrxltxNmtht ft.
32Q - j - ; ' It. R.
WellOan utorCodification
'Nuumber �/ f IS.($JW RCASINGtfinadY�md QAL NBA a
atat
(1°i . )CA,7f� V Cam' Lr r to t. t t� r 171.1+tea �vC.V�J ^ i 1 —Compaq Num t INNER riC oRout at+► ►r.
2.Well Cearlrretiva Penult k: ?..7 m �,
rJrtaYr;ppf/oa6lrueJtc+oet'sv ApcmW.etLe.U1GCmnaDss tti @/mrrn•efaJ ,„
3 Well Use(cheek well use): - 17.3C 113n1
WalerSrppyrWell: bto1 t• , ro , twetiaarr# atnretp¢ ,vOIcnmeea •_4ATtM. -,
As tl(ztral DATAipONPahlbo 0 a rt. in.
Itiential Water Supply Oleo) a. ' tt. in.'
Gsbaternhal(HesttrlglCreaiittgssnmly) _
lndutltiallCammerulal f Rsdealsiet Water Supply(shared) +3iQUr .
Irrigation la
la /���1�►�emo. ,uwMri.ac tnl �'.lu noAmmer
Non-Water SupplyWeue I r', 2b d. C t tt l�_ •►•t t1 V L-1
Monitoring DRecovety ft. ft. _
njemion Weil: ft. R.
miler Recline e..sGroundwaterRemcdialion l9 S.1tVDlt.'RAYBLPACK f�iel
Piler&crap and Recovery °Salinity Barrio PROM TO mr~ regmoeamsarrtuotruea
Aquifer Test riStarmwaterMingo n. a.
Experimental Tcebnoln y OSubsidence Control It. n.
Geothermal(Closed Loop) °Tracer 20 MILLI 41CLOGfettiads , ';,-'.,,;.•.". 'o==k cn uaMs�..aj
m CA0111 ull(HaetittilCoqiing Retur0) f otbfax erplain under#21 Retnarks)� FRO
x tf. i�� IL
; per (ri • _:
&Date Wells)Completed: Well1DJ1 61Z R 3 2..
5r.WelilLunation: Johnrn 4-Jtn+ Sill ai d nut. TV& 'Ci •
FaaiityniatetName • Faciility ION(ifappllcabta) it. C.
P ie/u�lAddtett,clp;and Zip4z1.m n.�RKs ., —_ 2r l
l,bcx� 1 •
Camay Patool Identiticatian Na.(PIN)
Ifttoii-T,Alir,it 'r..-co,':VA tj 0 r
Y.
ilb.Latitude and longitude in degreesbtdtuttexlsecoads or declenai degrees: .',`Gr2 e
Orwell field.ant leeAong ioeuinolgd) 2 e llfieaflan:
3S' 53 r<a 3�1 y 5A I ' �--E? a3 w Ail.; 3-cZ-Z3
6.16(afs)the edt(s)(PamuItnt or Dffemporai
Si ofCentr«rwdl Data
By iptium,kw(arw,I Hamby omrty AN the tvr11(41 toss!tram)coerartaoad b aeoa+dance
7.Ie this a repair to anointing wen: 3Yes or 4No ears 111 a+C,lC.A2C.4100 or ISA NCdC 02C.falld Kt Caarlritr>imt Standards and dw.rr
IJthr is a main fill ctelounin wan etratraction infotvtattan owl czplain the mum gide a0PYafJtirrccondMatt"P191fItdJcilr:WC(lnb4wr
rslrb ender i21 tomb section Dr&illm back oftbisfarm. 23 site Atavism or edditlt at well
8.ForGeoprokNPT or Closed-nnpGeotLe rural Wells having the Mello You may use the back of this page to provide additional well site details or wail
eamontstian,aoly 1 OW-1 is needed. Wires TOTAL N1UMI3BR oNells construction details.You nay also Much additional pages if ancemery.
MEd; . fitI'JROMONS
9.Total well depth below land SU dace: 4k=05 " _lit) 24a Submit this firm within 30 days of cumulation of wall
ottr•aampte wttr u aimyenr traurentru wawa sQudtQ' A¢aravtconstriction IOW follotring:•
la.Static water level below top of ea:ln •• _ (IL) Division of Water Resources,lofarmatlon Proems Volt,
!POWeP fin,IN f ova COS ing we ( MIT of,
Service Centel.Raleigh.NC27699-1617
It-Borehole dtane ice: 1 v (In.) 24b.For Inkenoe1 Vella: is addition to sending tits loon to the address in Zen
above,also submit ones copy of this brat within 30 days of e:omplestlea of welt
12.Wail construction method: t y 1,►�w/�+`�t construction to the fotlnwing: ,
(i A.oaegs.rotary.able,diced pub.etc.)
Division of Water Reeaurves.Underground Medial Control Program,
FOR WATER SLPPI V WELLS MIX: 1(06 Map Santee Cgnter,Raleigh,NC 276994636
13a.Yield(grunt tk" Method of ttsi es il 24 .Far Witter SuVely 40 feeiection Wenn In addition to sanding the Sam to
Mc addissi(cn) nbetvo, Watt submit one copy of this form whist')30 days of
r36.Disinfection t AMINOcompletion of well construction to the county health*pennant of the county
- ' where a onrttoated.
Roan OW-t North Cbrotiraet)cparemontoftinv4ohnteatnlQuill*.-pivimott&WaterRasmus; RevieeA2.22.2O16
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