GW1--03334_Well Construction - GW1_20230512

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. 828-622-7241 ' . p.1
Feb 1619 05 43p CteerwaterWall Drillingiiim,.......
WELL CONS CTION RECORD WW-11 For internal OM Onl
1.W 1 Contractor llaf gam -
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Well , va W D. A i 1 .. li
.C Well t'eiltattw 'Cettilleatieutit ill: taGOTSR ZINCt `t n r� ���
- c intGnM b.kri'/�/t y�lCVI YWM,n -LIVER `C OR �� I 1
2.Well COiNrteaetloa Perna 7O on►e(e �1 � L
'Mali ol,ltllm9le trailcrourntatlan pwmlls(ttt UIC Comny.5iq YaNmrea.e141
6. � I.In.
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3. Use(check well tint):Water •, vaoia r4 DISMRtl
WNtrSapp,We1l: rR 7tttcse!ittaa >stw't'�Gb
IIAgricultural f NttsticipaliPubllc Q o: a. b. artSL
bli Geothermal(tlestingiconhhtg Supply) aRRs stdeatiol Wa wr Supply(single) ft- is.
)r industtielfCom neraial f le$II1eI at water Supply(shred) oRour .Ill irrigation . To aimstrat. ��nneenn
Nan-War rSupplyWalk - ` b 20 &sea � ou ``'
- •Manit• '• _DReenvery a- b. - -
n ,•'-', I - ft. R.
■Aquifer R Groundwater Ramcdiatifn
Recharge 14 daMliGIRt1VRLPA lit!. _=iT .J�ct.: .T
al,Aquifer Storage roadReonvory °SalinityBttmv '1441:0r illal ...
21 Aquifer Test
1:.S4IYtmoter DioImigo •
al BxperimemaiTa mology QSulisidenccControt h- R.
ill Geothermal(Closed Loop) E371[ace xa NU LOG ,,;ns M
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. ,isisSeas)
fiux TO
Ai g exntanat teatiol(Cootng Remo DOSerfe> it 4r21 Remarks) ` u. t , a. 4ii ii ek-•.,Y •
4.Date Wdl(a)Completed: _ Wag 1Drl I t" =WI i, _ .' t-
!i WdtLeteetdnae i- Re ` ii Ile r/_ .1 1
OJIA.OUtg D i C\Cft• 4 Ft• 0— R. it"' '
yaciitylOwner Nano . Fuggy tfd( livable) It. 1
4
keel Mdm wdzlp �.1r -
=- v t t
j -heaMa,Cx r �21.tt MAR1�► ttntra.ew�,a •i?,..:A 2:i.g' -!
Canny Panel ldomiftcationt4a.(PIN)
Sb.Ltttitttde nod Include is dagnxa/mhattedsteends or dealt al degreess; i
(ti wpA ficltl,ane tallono iah 6 ! 2 IV , dawr ,
�' � Lo ; OS( en S'i .23 iv il 3\.--2S
b.Nam)tie well(s)' PaamtxM or ©lTempotary silt . ,f Certtficd Well ..tractor Dec
By atfmiog,hinter%1 hnosAy(XD14 s thin iAa nn11(41 was(eau)aoarttnaa+d in oeoy/ewe
i.In Ms*repair tonncebdigwell: rites or CNo. with ill itiC.ICa2C.01tmor15A,YCACO2Cdl1n0WallCoesi o:SonSmkdanbandAera -
1'chic Ina main flIasalmoxntuallaxtwurnxY&mr iwa,toaandnnprain,heamusrrfthe 4°14'411rurcrnd WWIIplst'lMtMh1WWiilAlvngr•
a;rclt under All=rub suffat orange hack of fhb fmm.
2.3-Site diagram or additional wella:bib:
&Far Geoproie,DPT or Cured-L np Geothermal Was baying the same You may use drab bark of this page to pravido additional well Site dehilt or well
atmilladlan,only I GW h is needed. Cndioate TOTAL NUMBER of wells construction details. You ntgyelna attach sdditltnud pages ii'rtocessfry.
drilled $pDMr'i?4L.lir'SiRUCi'(ONS
P.A'atat well depth he10w itlld Eil'fnect (De go 74at. ler AR W_ellbi: Subunit this fbrm'within 30 days of completion of well
Far demopk wells,n.au refer sl mtesanple-aeitioraaa:gtm enasiruciiantt►the fi11o1itDg:•
N.Stark wralsr level below top of outlaw .• • (it:) Division of Wetter Resources.Ialbrmatiom Processing halt,
Orate km!IsOhm ening Ina^•��-t 161TMift Service Center,Ral�lt.NC27emo-rdra
c
diameter:t i.Aorebote U�// I 0 (ia) 24b.Pm iarertioriWcUi In addition to sanding the form to the Wren in 24n
4/L o/► - above,also submit one copy of this form with1130 days of completion of well
12.Welt aonstritclhln methods Vl�i'l ctFnstruition to the fotIowing;
it v•nine:mart:cable,direct pub,etc.)
— - Dtvislou orWratter Rtaaurcea.11ndergroand Injection Control Program,
i OR WATER SLPPLY WELLS ONLY: 1636 Malt Service Ccavu s RsJdetgi,l4t^_276+)4-t636
13a Yield(gptn} Method or to mV '� 2 le Sur Wirer Sanely&t{alaeMlon Walt to addition in sanding the Rem to
the nddrees(cs) above, also submit one copy of this torn within 30 days of
tab Disinfection type: Amount: completion of well construction to the county health depatoaent of the county
where aanamtcted.
Iinmt(iW-I North*Mimi Ocpmmsicntoftiovlmanuiusl Quality-Malmo ot!W=litauatees , ResiseJ2-22-2016