GW1--01838_Well Construction - GW1_20240322

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- WELL CONSTRUCTION RECORD(CW-2) For liztermal Use Only:
L Well Contractor Informatbrm
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_o• 4-Rittdot..-- 14.WATER
. TIOXIDET1011
V.d1C1MtractaiNante . _______ _•-, - - ---- - - -
• - j51/2.-4 syn-e_ 2,,---e-,x--7.7/ IL' 4.-.0-1:5- -d-4144.1e- -tarttip____ Arto,__________
it.
NC Well Connate Cattirteattan Number
IS OUTER CASING(for nnfitkissed - DRUMM ft ) . - .
ale/44. Lt.fitet'et..- S.a i tag.a.t.S. 4,1.0... FROM 'TO MARINER THICKNESS MATERIAL.
CompanyName
16.1NNER C.ASING DIMMING(taithennal dosed-bop)
2.Well Construction Permit' 0: /17 3'....'tem i FROM TO MARIN= THICHNESS MATERIAL
rnt all oppileabliiell on strivaim- z penults(Lail=Coolly.Sate.Vadwjce etc.) ve°1 It. AA It. 0 In. kida r ir
3.Wdl Use(elle&well use): ' 7/11- 7 3 ft- Id in-
water ,,., .Welk . .17.SORKIN
FROM ITT MANNER SLOTSME TRW:WINS MATERIAL
- 7:
CiMunicipal/Pubffe 410 rt- 2/ IL
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Cpcotherinal(11calbleCooling Supply) OResidentiSI Water Supply(single) n. n. ' In. -
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t
OlndtustrinVCommercial I:Residential Water Supply(shared) 18.G/tour -r :
ClIrdigition DWells>MAIO(WI) FROM 1 ID MILTENAL manacnnusratenrons.aarnmer
Non-Wat7 Supply Welk 6 It 2f IL //isl701i) 1 0
°Monitoring • °Recovery a. : . . '
Injection Welk .. '
atiViOrgeji4.'•: • OGroundwaterRemediation
Bo.SANDGRAvELPACK(faiiplicable)' • - -
ClAquifec 3tcrage lad Recovery - CISalinity Barrier PROM ID rc MATERIAL EMPLACEMDMIEDIOD
• 1:1Aqui r Test OStonawater Drainage Z./ IL• 7 3 litik,e• er", ,a 4.4.:.- .
------- _cigiveFimPAR170.4111010RY-- _____. °Subsidence Connedi
Mediu:anal(Closed Loop) °Tracer 10.1111111.1.1NGLOG(2theduderdcoaldiedsffurceseary) • -
1:16cothennal(lIcalineCoortag Mum) Maher(=libitum&#21 Resijads), ER°. M„ 7), ,.. .7S931.P11°R"4341Erill/e2"1111/"LenAgcd°slit'cie4 -
a IL LC) ft. 4;2410 e- SA445., •
4.Date WeR(s).Completed:.017024- 74 Well lDff ex) a in IL &IAA 1t tilill le ,v
Sa.Well Location Kb R.ow'I") 71- It -77pq-
. . n. n. :
faliallA _
FacilayEet(irappiicable) \ . -v. . • . . . ., • . '
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._......... ......... .
- ft.
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- _ =BMW=
County Pared IdeseiEnation No.(PM) ••
... . ,;, ..• •. . ,-.. , -• - • - . . . • MAK Z• i
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Sb.Latitude and longitude in degrershninnteikeeorids or decimal degrees: • ' 20i4
(if,n,isrid.am Wilma is satfitivat) 22.i, i--tiam 1 -rirr-.';t2n: r:-./.:.544414.,sz anit .
at i 2-sr N ,qg°'.
. 45,..." I . .
W- 144VIL-f !eli ---, 130G• •'. •
- 01 Z1
Signature of Catiffed Well - Date
6:Is(are)Ole well(s): tikirmanad or °TemporaryI
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Sysigningthisfonst I Itesebyeettitraiat theireilfs)was(were)eieistrede in aixelikrecewith
7.1.5 this a repair to an eirlating'Oell: • dYes. or SNo 15ANCAC 02C.010D or154.NCet 02C.02130 MU Coegnusion Sundae:is this'that(levy
sides meted has been providedbitheweli owner.
. fthis is e i npaiu ji 1 I out known well I:cobel:Oa information and again theraftre ofthe
----- ---- repair undeetat rezei rk- ISteUrai oriel the badrofthisform. .
--i 23-Fite trragram or additional weRdetaili
. . .. . _ , -_ You may use the back of this page to provide additional well constroction info
• )1 For GtoprobelDIT or CI- Geritherand WeRe having the same
construction only 1 OW-1 lartTOT/AM:043ER ofwells
(add ee Oval billemarks Thnt),-Yonmay also attach additional prigesifneCessary.
. , - rcate
drilled:-• ' ' - . ... . . , . . .
24-RDRMIITAL INsI1dICTIONS
.... , , .
beiei;v; „,.,
'''"'' Submitilds GW-1 within 30 days ofvrell completion per ibefellowinr
r•-,‘ For multiple was Es sdI depths rdgerent resemple-.70200"and WOO I ,
...s. . •. •
.‘ 7Aa.For All Welk Original form to Division of-Water Respumts_tD_WIt.),
.:,. 10.Static water level idott top.if csid;40- , ' - VW •Infinonlion Processing Unit,1617 MSC.Raleigh,NC 27699-1617
Ifwater levet airbuses=Amuse"+" . . .
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ILiaireboteditUitetetz - .9 (IQ - . _. . . . -- . ... ,Mb.For Infection,Wellm OrY to DIM Underground Injection Control(RJC)
:Program,:1606 MSC;ltdcigklic 276994(36- - •-- —' - - -- ---- '
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"31:•Wellconstraction media& /77 1.45 ?a ArT 24c.For Water Supply and Onin-Loon Geothermal Return Wells:Copyto the
(Le-awn room came;(reereodi;c1c-/- '• — - - - —' '- wordy eovironmetdal health deportment atm calmly whereinstaned- :
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ypRWATXRSUPPLYWELIS ONLY: . - - -•
24d.For Water Was yroduleinf over 10041410 GPD:Cop3,to DWR,COCOA
... - , • Permit Ptusiiin,161.1 MSC;Ralemb,-NC 27699-1611
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13a.Yield(gpm) La, Method of test "p U 19
13b.Disinfeedon type: ode," gxtre__ Amount VZ./A- _
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Faun ow-I , Math CasormaDepattman ofFanfironmental Quaky-Division ofWaterltesourpts Revised 64-2018