HomeMy WebLinkAboutGW1--07118_Well Construction - GW1_20231101 '
Pr1nf Form.
'vzifL CONSTRUCTION RECORD(GW-1) For Internal Use Only.
1.Well ContractorInfortoatien: _ _ I .. .
Cameron Begin 14:WATERZONES { I .
Well ColtmaCiorNeme
f ..FROM. .."TO DESCRD'IION r:. - . ,
4518=A ',145 ,L;• tt
' ' 30 ap'v,:.
1 -
NCW ICoiamiorCettifleationli®het 15.OUTERCASING(formolhia+edeetls)'ORLINEll ita IIcableL__.-,. _
Aqua Drill,Inc. FROM . TO • _ .DL1IVrnizn., '..THICKNESS "MATERIAL
. tz' l it
CompanyName o �v -
(I f i&NNERCASING'ORTUMNG( tIMD1400D) ' _ •-
2.Well Construction Peian& . 047 - r(9 1 FROM :_TO • DIAMETER ,a'eus�s MATERIAL, .
Lest ascpplteable-fain.=1inzdtai"emits(Le.UIG G!1P Stale;Variance.dal ff. n tu. .
•
3:We111Use( weIIttse): tt "
-Wak!S •17.SCREEN _
J.�fai it Welt: FROM TO DIAMETER BLOTSiZE 7i1ICECNESS' MATERIAL_ "I •- MmdcipaUPubiic ft. ia."
ii•Geotbetmal(Heating/Cooling Supply)24esidential Water Supply(single) tt:. ft. , •ia._ .. , .
rif 7ndU�sii lI- 1Commeteial Residential water Su st►.
i. Ron •
FROM • ,---TO. -- MATERIAL' EMpLA ilIEruoD&AMo1Nr
Non-Water. -.
sDpplywen: 0 23
3R M I • ail^ .
Monitor on •_' E3Recovety m R - •
Rechtege
pGiODadWaterR®0diation
"19.SANDIGRAVBLPACK(itplleable)P.I • r SF end_ SaliattyB8Qit7 FROM TO. MATERIAL EMPIrCE6PUT METHOD,.._ ,
•." . .ariTCSt f
�StannwatecDrdinago
-II ExpctimntelTehnology OS bsideaceCflntrol f &,
'NI Geotleanl(ClosedLp) OTiacer , 2DRILLINGLOG(dtebadditlaaalthee4sHtiaeasI . . - _, - ,
•1• C�JtennalHeatiigCoolitimReu n) .nOther(explainunder##21 Remailts) FROM TO • DEscR>P I0Nt uma.>�.1W, kepe. rainsize. .
. 0 IL_ 3o ft:, 4Gi'tn4
4.na�Weli(s)aamptetel: Z8/2 ,� ft 965, . :, LAGIn.. '
5a:WellLotoatione w-_J\
Faw'htyl Name . FRCildyrR(d'appieable) _ - i N .. r;: -ir:, .--,
1 9 ���/, !! it: n �
l 22- ,�Z G(r rk/ . Or . - of: 1 iraV/ J ��`.1
PhysitnllAddtees.CitgaadTrp -. - " • _ • • _ _ .
31'REfltARSS ,� ''r
r
County .PaiselldentifcationNo(PIN)" = :"
5b.Latitude"and longitude fadt /minuteq/eecnndsordedtoaldegrees: _ ...
(ifwdl 1d;alp latlmngii mi ci *) .. 22.�6r_tiffaiHnn. , '
c
0,, .7 7 �,
►�G Z '
Si5Maiao II1ed'WI000noactor ; " . _ -
ri.Is(ar�e)ttie.Iencrsermaneat_ orTemporarY 'Dote"
911t l a repair to an willing
�: IQYOS "or o. .• 11.11 t:,_iCb C.Ol iSANCACG.0200 WrAConur.cco-ttu s a' :.
• Iimb rarepnicifIllonHmownwellccnslnction_ioforazatloii eplannthenatreofth e naPY4ft ieemidhasbnrnprovldedtothe, etlowno: - s
repairer)der:ll2lr¢n iiiis*21DJioroaAibackofNrisfonn.: . . - , . . • ,
.21,1 to diageani or a_d[tlonalwell&nigh- -
8.For obelOPT or Ciosedd t op Geothermal Wells having the same- - Yon may use the Zia*of this page to prnvtde additional•well•site details or ,
c °DIy�1(3W.--1 eneedeid-indicate;TOTALNUMBERofwells' " ConshucuoadtdaulL Yonmayelso:ettaCL1.40ititinal iegtilfncciisaly wail ,
doll SiIBA LJNSJRUCflON
6 S. ,
%To wee depth belowlinaturface: - !- - - ' - '' . . ( ), 241:Par Alt Wenn• Sabmit'BDt*•form:'Aitliin 30
Forrmt aigrAB7tito►idepins�l t(�e.f@2ae•and,Mien, ttinsint dontothcfollowmg: ` :Compleptton of Will f
mote_ Iav ofcaetD$ -( ) - _Invil o Res Drc�;Informtatton Piee- - Unit -
>8b' .
�tes.Retelgb NC 276891617, '.
IL de diameter. • For lovel
rectibrrWcil,E Ida4ditiOnft - '
f - ri cr ' copy of thts,fomi.,viithid 3D a
12.We'l conetroedon method: co coon t-the follotviayg ''' of compl il
Dlviit+fon if Watp.Resomioesr Und¢t�,o
FOR WATER SUPPLY IEU S ONLY - - -. IniteHoa ControLPeagwn. -7_ _ ,
• C'r' _ i636Mnfl Seivke Canter;Ralei�;NC M6195-1f1i6
13i.Yi dfEP»d 0 . Methodo. .7. l`•��j� aAC. sRR IT hi�,�,,����
the; )n addition to .
19b: -feetlon " e. , . Amount:. 32a- - • ComplatTa of ° ohs- �30 ,
�/ also submit an b
lyp �7" ern eonehttctiat to the mmitq of Use',of .
C°uats!
rpm nut - • No:t6 Carom*-Deputmeat:ofEnviroameniaQy wow.
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