GW1--04421_Well Construction - GW1_20230710

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WELL CONSTRUCTION RECORD(GW-11 For IntcrosiUse Only
I.Wen Contractor Informatiem
—
Cameron Bazin
14.WATER ZONES
WotnCent:acterNano FROM TO tt1oN
4518-A ZpS jDc3 `"f'
• n. R.
NCWell Caatraetar Certification' Nontsa -IS.OUTER CASING(kra niti-used )ORUNER(if )
Aqua Drill,Inc. FROM TO DaAMETER ,Trncxiress a �u� �H��yb,�e,�D+L
CaMPagyNEM R 4aS ft. is l /'v�.
� 16.INNER CASING CRUISING(Reathenag doreddaso)
2.WeBCe:ntra Permit& "JeeOl 16 2. FROM TO DIAMETERTHICKNESS
MATERIAL
Leta(*Okabta unit wa shaaioapermits(Le.U1G County.State.Variant etc) R, tG to
3.Weil Use(clack well ese): ft it to
Water Supply Weil: 17.SCREEN
vimTD DIAaQBTER SIZE TRIMNESS MATERIAL
?- , .,,.. * ,icipal Public ft. ft. jig,
)�Geothermal(Heating/Cooling SuPF1y) )I R sidmtie1 Water Supply(single) f. IL ht.
I IndustrialiCommercial *Residential Water (sbate�
�zati
� 1&�ROIIT TD MATEurAL t9tlrzAcahffirra7arxOD&Arrmrxr
Non-Water Supply Well: 6 ft. '1 Z ft. ,,)fr
*l MonimtingRecovery R. ft.
Injection Well: R R
r 4utfa'Rechsoie OotoundwaterRetaeiation is.SAND/GRAVEL aACiifitappite:nle)
IN • ; Stma$e wzd Recovery E3Sallnify Barrier nom TO MarRAr . fitdrlettBHEhT MEiTtOD
11 • - Test C3Slan waterDiainne to ft.
A 'Technology ©ISubsidenceConin,1 R. Fs
a Geothermal(Closed Loop) f]Txaca 20.DRILLING LOG(dtxb addtitasi sYct�tf etsar9)
II Geothermal�5 ) C)Tha(explain uodec021 Remarks) FROM To DffiCRSrioNtm�e lasedam wrack me.Wn.fs.ael ,
4-Date WeR(s)Completed: 7/,/25 WenD20 4 24; e
f
Ss.WellLoeatose 11
- (tee /'iuu.� ft. R 4 w{ T.ni
Name F:crTiryIOC(ifrpplicabre) tr. tt. _�`F_,:'`6- h N' =f
IL IL
�,S i s 3 rie7at4 l`11� _ „ e �n� t
Physical Address.Ca fr.
U.REMARKS
C raced rA�TMsmttmNo.(PRO
n}; �'
Sb.La nude and longitude In degcaeslmiaafesfseweds or dedmal degeees: —
reli fold,oao fry) �10 3 W zz.crr8sattiea:Qf
'I2 ,9-6 3', % N gO ' 2 — ----
G.is(nre) --
• the wrIl{a asuan or �T s wen of Wau Grm�dnr ... V-7 3
By s(gxtnt this jam,f kenbyh that WaCsJ esEa( oaarrtraretd ha aomrdozoe
i 7.)a this a repair to an ends6xg well: EDYes or WA 154 NC4C 01C.0100 or 15ANCAC 02C.0200 Well Coaspueuor awl that a
1. s isare4jzicothewnwelcnatar+ulete gad agtau,rheoouar,et5e mar ofair,rmrd has beea,proatdaamtaeRNmMei:
r trder ill ra�iFsscttac or oa thaDadFoJtlrts a.m. 23.Site diagram or additional weft d i
8.For GaOpaoltrlDM Or t I,eop Geotitermah Wehla imvirig the servo You may use the back Of this page to provide additional well site details or well
8.FQr'fl. mly1GW-1isneeded.IndieneTO?ALNUMBERofwalls Ad a You may also attach additiunalp ifnecpsaty.
• drilled: rJ SIBNAITAI.IN31RI1CIIRNS
!.Total wee depUt below teed surface _‘S (ft.) 24a.For All Went Submit this fawn within 30 days of completion of well
Fartaah/Wewelts&mg l ( 3��'�I��) construction to the fiel2owing �'
IL 5 bttiC watt lieFd balm'iSnp of asiey �'� (IL) Division of Water Resources,Information ation Processing Unit,
/fewer Welts abase rrse"r- 1617 Mafl Service Center,Raletgh,NC 27699-1617
be
I]—Borehole diameters fie,/ 241a.j+e Alec n Weds: In addition to sending the form to the address in 24a
/^ about,also submit one copy of this form within 30 days
12.Well m > � 4 ���-V construction to tam followiom of�ptetion of well .
ii e,agas.mugY+wblg dial etc.)
Division of WaterYiawtrees,Underground Injeetton Control Program,
FOR WATER SIMPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636
+Yteid( ) �p Method of test: 4 t''`4 lag— 24 Il m�►mer Srarml*6c lQteetioa W l a In addition to sending the form to
fof this ham
131t.Dfst feedon aAe: Aaaonat j�on completion of well Tonto that health within 30 days of
tad department of the county
WerthCu ea olDcpanmentofEm ua sant
FarmGW-1 Quality-Diy{sionefWaDerHms ooes REarised2222018