HomeMy WebLinkAboutGW1--03291_Well Construction - GW1_20240603 , 1,
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Wfol,..012INSTRUCTIONliECORD f or Internal Use ONLy.
l'hiiftanti=be tilled for single fir multiple wills.
I.WOConirstetorinfnrmution:
14.WATO 2.0NRS 1
om • TO .FR .. DESCRIPTION
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Weit:centrectorNathe /at f,•19n* d' .) g-PM
ft. rt.
i 44.-4-
-15,OUTElt CASING(tar, ; %cased svelltLOR LINER Of applitabie)
NC,Welt Connector Cettification Number FROM TO 'DIAMETER THICKNESS MATERIAL --t
McCall Broth Inc. .1ki ft. In. .:
Compan Ham Bt.INNER CASING OR TUBING(aeatheratalekleed400n)
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FROM TO DIAMETER ,.TRICKNFSS• . MATERIAL
,Weil CODSITUttiOR#eTIllit-#:. /10415
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rt' 75-n. r 6 '°. :? 7.- --- PVC_
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ldst Ril applicablelvolkOnstruct$44 penifit 0.0 Calor,.Star.q,FO-411./rNs ii1C.) n. ft. l-
I Well llseltkeeltWell use): -II scurnm. •
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Water Sanity IV FROM TO . DIAMETER. SLOT SERE TOICKNESS MATERIAe
1 * st.
ClAgricultural phdinj:Tipal/Pablic
OGeotheranal(Renting/Cooling Supply) •* ..rasititartial water Supply(single)
OlittlastriaLCOmmereial ORmidentiril Water Supply(shared) is'Ck0uT, . ... ...
Moat ...I Ili '14ATOM Al .thirlAcsbnsmr IVIETROD e.amoubrr
1:11ri n. ip% ft. /1 ft. (..i
,Bed.,46.140e. "4/w,.. ,N9P-Wsiet.SuPPlY Weill -104
ft. ft.
,1-alvirMitering 1:411ecoYetY
'Meek's Well: • • . . .. ..
ft. ift:
ri Aquifer Recharge •tl(lrettattatator-Matadi anon It SANB/GRAVEL PACK Of applicable)
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....IMM fa AIATEPEAL EMPLACEMENT METHOD
C.)Agatha'Storage and Recovery Ofirdinity MOTO ft:. B.
i nAquircr Thst M1rirkilt14 14.r Dra ilia* _____._, . • .
ta• ft.
1.1.11Expetimental Technology 1:1Subsiderter Ondrnl.
tloccithennal.(00ted Lew) =teem -2e.DRILLING LOGlintma additional shade If necessary). . .
;Matt' _4'r0 . DESCRIPTION teoler.tisane**,saWrack tiiktirate:alar.,eta:
I3CMOtimfmlii, 'tas..:Conlin: ' , , .- BMW(A l4n:tittder'411tetuaticS) CD I'' 1/7 ft. -',Ap.,....co )Z
4.Datt.Well(4)Ceiti dr II ---/plete
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Pc(k-
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ff. i2_0 ft- -7,„5- rt /J„,•\,),Ve---
Fillathyi0Wrierlierne Fari lit y 11 iP.drepolicable.) --7..- , 'e- 23 -----sd414117
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-ft. It,
i1i)7 /. c) t( 1.20A4) .0 9.15 _07. ft. , , _______
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.1,1;iiiiadiAddtese,.City,Ind Zip 21.REMARKS . . ! -
leVAZ-AAJA----,
• Coemy Pareeil'ityZinctottas NO,ft•liTt----- .L ,,U I 1 V - i 07 4
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„Sh.Latitude and Langittide ln degreesinsioutesticenntb so-decimal degrees: 22.CertifIcationt
(if wall had,nies.laWleng is setycieet)
iii:cifig 7,2, i T4 ,I_ts ___ w,. isIlic A 1.1 4/...p. .._ 4,4":",, .._!
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-ige,.....i.ccrtlteXcTo7= &le * . - -
6.It(are)the Welk*: ? nanent nr PTetriptirariy. Itysigmbg tab./brat i hemby,e...r_rio tliatilievefiN as rwe*ceirstnected.61 actorelabee
../7-". with./54 N'Crol.CVC:OM)or 1.3:4.AICAC aW.aroll-Well Construaltnt StandstrIT and that. c
i.,If fltio.a xepfaitt.0 tug existing wait :CMOS Pr. AFt.tftktt copy of ihiiwor001.0.1ifrrDpenviclaslio the well mow.
frook.it dm/Yak:tit/that known wail caost0140.4 Ifird.rWation Ota ontlain•riii".401f,re qlWie
*de R4.aer Virelitabt WOMOVW.0 i f Sitehae.W.1)08.1rnr. 23.Site,diagnint or additironalsven dettins:
You may..nsti the beck ef this page le prcAtide additional well site details or AMU
8.Nunstar of wills constructed: 01 e- :construction&gaits. VoIrMay also attach additional pages if necessary.
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Pax aliNpir tyliection.o,non-mtie,supply vs.&. i.)!with/hi-serfar el,ASIIIIL*04,yd.,mil
st,ftir.NW Prat, 24,Submittal Instructions:
9,Total well depth below land surface:427 00 .24a. For All Wells:. Submit this form within 30 days of completion of el,C 1 I
FOY Atittripitt N.41LvILt:ell ddioils if Afferent(examit;. gz.on...iria."*IatT) .comIntcticiti to the IbIleaing:
10.Stade water level belowte, melsigt h ....,_. ...... _ (04 DP/hien of Water.Quatity,Information Processing Unit,
ffiourei,Tivei&ithin*vitiftig,use:.4'.. 1617 Mail Service Center;Rtdeigh„NC"27699-1617
11.11ot-chola diametert. J4 1/6 . (mi.) 24b.Far inieetio.n.Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form widths 30 days of compietion of well
12,Well.cenettmedoh*died:itai,4„kibt,il construction to the following:
0.e.nu*ratety.:cable,directpash.„eta.)
Division of Water Quality,Underground liklection Control Program;
• ' 1636 Mail Service Center,Raleigh.,NC 27699-1636
II FORWATEit,SUPPIN.WELLS ONLY:
A C.)
1..3:I...Yield tom) ci i i. ..1,
lotitnd nr.rem:A/12,1,1 i } 24e:Eye Water Supply&Geothermal Welk; la addition"to sodding the folio to
ih? address(as) above, also submit one copy of titis rm.tvithin 30 days of
. f,
13b,orealt.e.cti"tor. . 0 i . A =nit 13 i__0_7, ...owi., Of 'Atell chastruction to The county health department of the ommry
where eons::imied.
Form OW-1 North can4.0,,i',!Noonan;.of II.rwlromucat mut Is:antral ResnurucE-DiAition ortVatar Quality Revised Jan.2013