GW1--03407_Well Construction - GW1_20230517

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Feb 1519 05;43p CleatweterWell Drilling
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628.822�7241 � . p,1
US L CONSTRUCTION RECORD(GW-11.1 For internal Use Only:
1. 11 Contractor Information: _
M\e 2v'rf./ 05 14 WATER ZONES
taoo.r fro nsgcauit t
Well Contractor Aiame iG fr.
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NCWdiGtatagtuCatifiwi.n Number
6.tic G(Rrrls LY ,weld4$iJ tirt►E.011 hk)
..'. r ale r \ 0/i On I.t.(ry ,ro �ii. . : ,,
Company Nnuto •
OR
2.WcU Con>ltraeNon Permit tk g 51 ss TO r DIAMETER Tel _MA, 4
fatal(oPplicabfeutd/eaun tonparmttsP.{JMGCmmry,SIa%c,;Wan eta) ft. ft. •
In.
3 1,Ydi Use(chair tad!use): ft. iD
Wata-SappiXWel►: IT.SCOli Piro
ABricukural DMunfcipnllPuLlic a. otannerok TA ' •nttemassa ma►rentai.•
Gcoanermal(ileatimarCooling Supply) Igtkeddential WaterSuppty(single) it. ft. in.
tndusitielrcommendal f Rtsiudemial Water supply(shared) 1 ma; .
ion 'ro �M hr'tzitui. l _.atttn )++lfc�rr a AMopta'
D.
ii.
INIon.Water Supply Wells
Manktrrir _QRccovery ft. EL
-njeetian ell: "�
Aquifer reach �(iroundwatcr RcmcdtatitmIII SAND/GRAM PACK(([ tp 1
Pifer&Wraga MI itccoveiy DSelinity Bather pm 1 LA t,
AquiferTcaa fSmrmwatcrDrainage IL IL.
Uglerimeaml Taaltaology aSubsitlenen Control ft. It. ,
Geothermal(Closed Loop) D&acet EL DR;t.1.1NG LOC Wei NU bacestaeyl
Geothermal(itestin Gootinif Return) °Opts•(mtpmin andor#21 1ttmarks) t1tR TO m matt
erttrArsir3�rhte eta►
4.Dale Wdl(s)Completed:`t-- oa elt INTt9)rt• 140 l' , C [ 1 /�[C .
Se.Well Luanne:Luanne: \'� (MAA (.4 x- -
Toe, m roe... N I rr i�,S ft ,�U t _
BactlN]s'(hvner Nam. Emil*,1Dit(ifmpliethin) II. ft. . ' �„t„ . 8-t 'k. F 1.
r .at addmss,Cliy,and Zip �e )�-�t % n-. r M NY i 6 °[1013
• srLtarmARK _ - I ._ - Li :.
County Perm!identification Na(PIN) ,... { fir, �t '
SD.Lntitudt:and!on)pltade in degteesteUmttordSemnds or decimal degrees:
Orwell field,one tatlbnginnufrteicnr) 22t, done 1
a51 �v�' (-1- 0 NI ba�° 1 ` 1 w 4-q -Z.
6.Ie(are)the wdi(t rermnaent or OrI'eatlnorery Sin.atere att3atimwl Weil Contineter pOe
7.It obis a vpios,lair(bra;1 litaellp cmtOtOmt the scrip)was mete)coat rcfed 6t naCnardtd e
re/rah-to rive, or urn►iSitiCACo2c.p?t711nr!SANCAC82C.0280Wdf(CuxrtmalmrSimalardrnmNhma
(frhrr xramialli fNautbtnwn wrll.twwrueo»n b nn ton an the uan,m ofd}u u+AY nfilds ream')imam pmtlm1 h nhe well miter.
Muir Neer AZ1 mattlilr>rWM oroink kit Ofthtsform.
23.Site diagram or additional well deia11 t
S.Pnr ceopmndBP'1'or Qa6edd.rmp Geothermal Wells having the same You may urn the back of tirffi page to provide additional well trite details or well
nonsamellen.nolp I GW-I Is:waded. memo TOTAL NUMBER of-wells construction details. You may also attach additional pages ifntuC cry.
drilled:
E; PMriTAr 1NbI RtlCI1ONb1
9.Total we11 depth below land surfor._... 1 U-S— ` �+ ) mu. Po`All Wartsnb,nit this form within 30 d of
I.a..nwWpl,wrr:uv..rs.ny„c„r.�z en. +mom-s�ymr atter2 neoo7 smrTi.nao of well
CgnBttlnaipfl latlhC following:• -
111.Stade stater level below top of eating: •••_ (ft.) Division of Water Ream roes.Inihrmation Proceed*Unit,
If wale kW halving casing,nag Ib17Md1 t ralec Caster, Ne
G Weigh, 27699-16i7
II.8onehaledtttatatcr: (
i�0tc� (In.) 24b.Bttr Lietetittp' ell fn addition to sending t loon no thtt address in up13.Weil eolntirttrp(gp nat6ud 1 V ��1 el 'q also submit one copy of this form within 30 days of completion of well
(l C.sage rotary,ruble.thetas push,etc.) "-"-I cna teetien to the flrtlowltlg:
IAOR WATER SCPPLY WELLS ONLY: - i)Ivtalen of Water Retttpxces,Undergroundirpeetloa Control Program.
1636 Malt Service Center,Ralctgb,Tic 27699463E
Us.Yield(t'Gm) ac) Mt t)trul aF teat: '1 24e Per water Sanity&ttafection WAR: In addl gion to sending Mc Dmt to
13b Disinfection gmnddress(cs) above,also submit ouc copy of tits form afililirt 30 days of
type: Arnormf completion of well comtrataion to the colony health demunnent of the county
whore eonometed.
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Fenn OW-I North CoolianDepnnmontefrinvitabittenelQmaity-Envision ofWarerRasometa I Revrned2.22.2616
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