GW1--06681_Well Construction - GW1_20231017

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Print Form
- ' CONSTRUCTION RECORD'(GW-11.: - ForTntetna1Use Oply: •. : • •
.: Cameron..Bazin - . " • :14:WATER ZONES r' : . : - -
1ValtCammiieriv�o • • - _ -- - - . .
FROM • 9'0:� itL+4Clla'3'tON
4518-A : • : : .. . . . . '3 4,' : 'r,�^ - . . - - . .
atmebttkstiftlionAtnmber CASING(ramie-easedwalls)ORLIl ER(ifa ble) ' "
Aqua DNI;;Inc. . . . . . . .. . mod
•n .TO'- . m rmanvESS ' b,A,» -
o G elosed-Ioa -
. '1fnIIslPTER' G RTUSIItI (aeat>ttrmal t+)•
Weil Cna�Eioaa peru It . - 37'� .• ' '•• FROM TO- -. - Dimartla THICKNESS 9TATB!UAt•,
itst ail applhaateW4ICvnstiuctfoaF• s OA MC.Qnau..'.Raft Verb eta) (�, f� �'
3.Wal Use(eLeel well ase)." : to ft. . . iu: .
.' Wats.SupplyWelI: .. - - . . goons E a
�I _'coltueal DTAM 1Cu •SWES R TRsesrnoR MATERIAL
MumicipaIRublic. & > (a.
' it Geo henmal(heating/o liO0 Supppy) ya I• ,, ., Wn�Supply(single). . f ' :. .to ..lit.; : "
)il Iaduitdalicommemial ' , lit Residential Water sipply(salted).: -18.GRODT• • - - .
Ili,: on .._ . .• • moons m MATERIAL Ee�rr►►Cetvz�t e�asoa&,u►somvs
-Non-Water supply Well: ' : • O -'1i ft.. .,G Q cb . .
9l Monitoring :.. : '
a 'goifer"Rzchatgc . • • _• •"DCuoundwaterRamedietion. .'• '' -. .
• • • -'19 BAFIDIGRAVELPACC(ifi lienbls)
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it•gnlfes•StatageendRecavery .. ElSalioi►YBamer . - " Thom . . •To tonnosAL - EMPLACEMENT METHOD
Test .. . DStcnmwatCTDsamag0 ft:: tC.
Exptaimeosai'Teebnology OSobldeucecontrol. . . .
• 1•Geothtnnial(Closed Lcop).' : OTiacer . .• " so.m:tux:io LOG PamaLidatHennt awls giu l ." - ..•
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• l i QeoihesmAl(Heatiag/Coolin4itivin) ]Offiee(explamunder#l1 Remarks) FROMago •
..5:DES srno..- _1.4 ;hI d g aJ T•sx. - . •l�•l
• 4.DateWe]i(s)completed: - I C /1i1i 'Wen NM �' �1ZS . - • . . • - - -.
r at ��G GL •
Sa.Well Lotortlon: • .' (L ft:
. . . .Jam . .koc{t:.S..•.'. ... - . . • . . - • . . . . . .. . . �, _ -
.: ' : . • . rarriitptOwaerName . • • . . .. ' •.- .: -• FEnnitY.IDS6fotiPitolA0: • ' • • . . iZ• ft:, ." . :;-f•-• ''- .
"D006(Nv,• •• ( P,b '.PAW - - ..r a ram.
• • - ' FhyskhlAddmis;C,"sty.anclEP: '. : : : •: . . " . : • . . - Ut, 1 .¢ i 9J1 n .
. s1:Rsnit►nss
County :. PateelIdemtHtxutonNo.(PIN)
• 'Sb.Ladtnde and longitude in degreealmlintte!Jsee®nde ar deebnd degrees:: ; .•.
'OfwolnSdd.o'im inVtoagissn�aTm2). ' • • :22.Certifteat(oiir '
t� 'rf• .
- 91�mceofCettTedWeUCantnmtar /y'��(`f'
6.Is(are)the well(s) etmanent. .or DTt m*y' . . ..
., � - ••:Bp 4g ills'+ ,J hereby 36''thm the a 'ins
•.. ' •• tviQO ' tivrrel•oo)asraetsd(n acra,eance
• 7.IB tail a i ilFaGr to aim kisNngtieR: • Ill Yes, or No . -• . yvtth HA.New o2C.na cirisd NCACOiG:QaDo IvaCoti7rud(an Standmc r mutant a •
Jfthiai aarrpg(,fil o{tfhso►vas+ella:min:Wanfiife:mad' and explainthersotaroofthe a'NO hhrecordimBeetprovlea(totltanBllatvnm; • -
t�afrsmdu#2!>mnmfasmeilanaronhabackofIldif nr.
• '23:Site 6ing ram oraddittonelwelldetafts: .
8.For"GeopiobeJDPT or CIu red-Loop Geothssnwl wells having the same., Yon tttay itse'the hank of this page to Fmvido ndeldonal Well site dataiil5'of wen
co Suction,only1GW-1ismxded:htdiwte TOTALNUMBERofwells �stsactiond�ailo.Youmayralsoattach eddoioaelpagesfa „ Cl
dtiIted: 5uB1:11TlAtt.Aasrt3IIC�1ON5 -
- ' 42s _
• ••::.Aormnlrt�te w andepr� le-3c0.2 . r4a p atr) .(�) masGnation to the following:t'�s tbtm•within 30<days,of completion,of.wall
. . ' •: 1i.stat(t:weterievelbeawtopofwstogi t40" ( ) 'Dlvhito,ofWater
,umextendivninnyauk&are'4'77 . . vice Canter,
Ralei h. Processing Unit,
Jf � • 1617 Meal sure Center,Raleigh,lvc z'6Qs 1617
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-11.Borehole dlsinat�rs .6 too • 24b.Fbr eekss:mn ze : la adt6tion,to
' 12.'Well'•
conetrtaet�laa methods • At I " • ab subtmt one aaDY eiithis form within 30 d to the dress is 24a
ova. ad
(a con:'trac�ontodi:following of plctlua of well:
• . < :ibis.eager.telm,aablq d'acctptislt,ma.
D1vWo 'n of,Waterltnomrc�>Q
FOR WATER@IMPLY WELLS ONLY: quad bliect(taa Control .
1f35 Mal!St�(oe Ctenter;Rsleieb;NC27�9. 1O'
13a.Yield(gpID)' Method of test: GJ(• # oo , Y r.a r.,
� (C1) aboe.ilao"`subaoitine'"!'apy ofa Zstg> �im �`
. '13b.Disinfection type: t4i l3/4 Amount ottoa of.well�t ew°t7 h Ids depat>;meat o e
cnaahuctcd, �• +° µ' cOtmty
g�aC,p►.l NaahCeotianDePtuf0te£BnvLcaameot.IQ ,-AivhbaefVltainr 1Ras�omcen v' •s� .t, 4s
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