GW1--01836_Well Construction - GW1_20240322

•
•
`WELL CONSTRUCTION RECORD(OW-i): - For Internal Use Only•
print Form.
•
I.Well Contractor Infortnattent .
Gary Thompson .
. . . -14.WATER ZONES . . . .
WoUConIn torNeme Faoai To atr .
. 4418-A. dcrSR,' 'ti.�}a.�' • r 4 e_ra'::
. .
��:Ups
.NC Well Codtnelar'CptificattanNumber-
AquaDrill,inc.- . .4.OUTER CASDN(i(i'erinankadaiwalb 02 LINER(lt )
FROM TO. DIAMETER- 7eec:oisas.' 1 MA°zanw,
Coma»axame, :e.fi L. .ft.'"- ers; 4t)� .�: Qua
2.We11 Coiutraettoti Perdmit '#:1 Hw P'i3QY.` i. FROM a•
c SINGORTI ( dsed.�,a) . .
NODDED- ASS MATERIAL .
Lfnail4Pplkn6le xrl1 cols done mils(4.WC County:Smta�.i/aNmdt4i�) - f tn, . .
. . :3.Well Ube(clieeirweU user . . ft.. • .. ' ft. .:• v:
- "Water Supply weU:. 17.6CRWI :
Agrfculiuta1'. ' . •FROIIi !TO. ' . DUMEi 10 . SLOTAIZE TRICRNESS . MATERIAL .. .
� ..��,•
GeoUtmnel.(Het ig/Cooling gitpply): dentiall Watdr Supply(tingle)' ft.;. - - .
Industiial/Commeieil.
: tlel water$tt i6(8 Ia.Gt:Oiii .
• rQiesiioa. •
1Vott-Water Supply'Well: To' MATEsfAr.'. . : �m ACEM rrsDS7ROD& OII Q. '
.. .. .. ' •• Monitoring,. - . b .- -`z8 ew w:. . r
. Recovery. . - • • - ' at. : •':gAq.l• . : • N'• • . -
•
. Injection Wells: .
gaiferRecharge
l lteetdiatlen•
;Offer$tottige and Recoveiy: r • •19.SAND/GRAVSt.PACK( aindleebk) _ • .
•
Aquifer Test. • • • .'DSO ' ro:R•• - .f• erAt�irAt. r�,►c�uatrrt► nroD'
Expennietdal Technology. Thainage :
• . �sbbaiaeaca corrttol.
- • . ":aheimel ClosadLoOp) ' :�74axr • 1DDAILLIIf.
GL OG(�cbdditfonYa•h.w.
ltirueeaus): ". :
.
:. . . Geod� ODun&�nY-'fOdiec(explainundei l:Re> )- Ro►r -: .ro DscRrrnoitl.r,t�uss'actneek e1t,6."I' --
d.R. ft.'
. -.C/A V .4.Date:�Ve (a)CemP1 t�: � :i " 'W: .Wenm� . .. ' : )f a' A: wcf .sr z:;pi
•
.' Sod/Sa.Well Iocaton: _ � n Q4rM �y'L...L1IA .LGdN y1 '4 •i . + 6cA:r:.. :.FaeRty/OvnerName.' RenyIDO(itaplea ee) . h_ : ( . .
-6
PhYskal , ,endZtp,- . .L,/ n' O,Ua a.;1` r .,►t. .--".• '. .,.'.�"^. -s. "' �'� '�!i. .
•
- I, -aC.tn/f j:.A1 2LREMARi;g 6
•
Y : ParcelideniiSaWaiNo'(PIM :• •• • NIK� 202?
sb:>aeaae•
and iongidide ii de miutrtdteconda ' •f.
ofweii.A.id,oriahtlbog;;aat)icioatj urdeetmaldegrees: lltifv .._ .,. s:.a4.f Ur., -
.22.Certlfcatlea: • Lira Cti 0 %
/G.. .dt 7-7 z.. ,w •
p.�.., .: •i , �- � ,. .:`'Z' :
6.Is(Rre)We W�e1i(e er mettent . or es . Si,... , .or�; W //�
continua' '" Date
•
7.is thta t*Parr to:Hi' - �' g t i,One,l h•reby'cnef dhai the ue1i(�,wan Omit)cbnitnrded bi acegidahce • .
: rt i t i a!rIalr.',Rll out to:Hi'wn i►tllt i Or '"�'"'_ Ada lSANCdCO2C.0100irrl9ANCAC 02C.0100 WeU.Coinbvdfon 5tandairb pied that a•dd6rmadonagderplo/nthe.t:00000d • : .9".ifthbreawdhaabeenpuaiidedrorhe owlet
. •fepdtr:meter##3l reiddsaellianoroblhebaekgrabfi m: : ,'. ' - '
T3.Site diagnin:or additional.we l details:-
&For Geoprobe/DPT•or Qosed-Loop Geother:nal Willi#teeing ttte. Yoe m ay.use the badcof this page,to piovide additioneleief cite di its or:well
.constriction,only 1 OW-I Is needed..Inicate TOTALNOMBER'ofwefs COnstacUon details:You may also attach eddtanal Pages tfinecetsaiyc._'drilled::
9.T al�►eA depri below land ttitaface: LA .' • • suanui to.D�iS77t1TCTIoNs. ..i,
PormulrtpiewiarUnaAdelxhsfrdifeida(c ampto-3( OWandand2@l00)• - • ) .�cotts- ctltt- I within' 3a days of.compl�lon•of.well
10:Sttktva ter keel below.taPefeaatng: �^j).: ! , .
ll allCWaaboveeast%ase'y� J 1 (�) D1tLion'Mil
,Informtit[onProcesdegUnit,
:1617 ServleeCenter,IWelah;NC 276994617.1L Bceehole dinner is• - • •Ca,
• (ht.) 246`For Ioleetion Well,. In addjIio to sending the form to the address.in•24a •
12.-Wen oristanitton urethra:•• a•�(t{C1►-. - 13t:✓ e>iove,•niso sebmit e copy of this firm within 30 dayd of iwmpintien* f well
•;14aoser� Y:able.dt at %eta.). nstructicdtothe.follonowittg:.
•
FQRwAT1IR SOPI!LY WEL - ONLY:: :• 'Widen of Wat�er.Rosanna,U deegmtindiefeetion Control Piu ram,
! r , •1636 Mai Service Center,Notelet,NC 27699�-1636•
• ',13 Yltld • m); ►
F 3,. . Melhed ofletft i C►s &k to►34t.•. :24e.Fi r•Water'SoD1v A.latedalia-WeSse In addition to sending the form to'
136.D oa.ty�. ant-{:`'l Dii. -Anrottttit: • 1( b/ cotnpl Ofwela l•constructionpit-one copy` he tti.depaiment within oftt County:
ty.
whereconshucted: : - beeltll.dEpailntettt of the d9ouaty
Penn ciw 1.
Nob(:.iolleaDopufmoatorBnvh talQadity,Dlvieion°MaterResarices i - • Revised2224016. •