GW1--03377_Well Construction - GW1_20240610

WELL CONSTRUCTION RECORD (GW-1) • For interzal .rse Only.
1.Well Coat-War Information:
RUSS811 Taylor : :4.WATER Zara
• PROM ! TO • ZE5C11111:10N
Well Concesesor Ns=
2.187-A 91 I0 ' ' H I t.
—
. i
NC Weil Conn=Conifeation Nutcher ,, Its6—.15 rio —
L.cram CA.StIG Cr mold.cosed walk)=Lana crsolegoko
gladden Brothers Wet Driiang, Inc i PROM TO i DIAMETER 1 1X1431C0005 ; 14=1,404.
R. f.... 44
Company Nome •
, Id. NER CASING OR TIMING arecethereted ofoori•loon)
I.Will Coutrucson Permit*:0701"07/.3(2 - q-1.7843 FROM 1 TO 1 lat.‘stEms. i TEMENISS I MATS:CAL
l'Ul all opplIcaltr nil consensaiga Ferzniar(1.4.OC.Catgray.Stoic.Agriance.Gic-) I. 0 1::.
i , C) It• tg tr. P VC
3.Weil LiSe(check wcil use): 6C) It. .: 6.2 ft' to 1 .488 :Li. TEEL
'irater Supply Well: i 17.SCREEN
I PROm I TO 1 DLAAMTER ! SLOTS i Nur
Apienkulal Deb.micipaYnbii:
Gleatbd=111.1 aisating/Cooling Supply) EResiti ...".4 I Watm.Si..1:piy Ct,giel i I induscial/Counaccial ,.. ,
DResid=dal War=Supply(sac ) II a.GR
•, oth. fr. • in. r
Non-Water Supply Wall:
Monitermf
intim Well;
cif=Reaust •
' Storage and Renovcy
cater Test
E.xperimental Technology
Gtothensial(Closed Loop) ORecravery
In Crronr.d.wz.inr R.r....-1v....izzion
rr, aii..
Barr:c. :y . •
05m:rave-a=Drel..a.- to
t=.r. .
'. :Suaside=e Cozzoi
77.rao...
FROM : TO
i ! MATERUL ntrt-ACT.N=T 5.1trffOri g
I! OD It" 1 20 It• ; cassr.ri...r-a ouitgee
;I te.. )
i
fr. ! O. i
It.
III :S.$ANIKIRAYEL PACK cif zoorteable
i FROM i To
i 1
;!
I
1 1.- .
f:.
_r .r r.
..... .
r`
CMOthennal(EleatiastiCoolthlt enum) nOtam(=ninth;old=t-zi Reatants) II -
F . ,ANTFIZT.IT
ncR.07ruoi c.T.,.;-OG,zasch acidil inal shwa if or-temarrl t!'n."47:Nrt.4.r"311
' DESCRIPTION moor.eweawsoentreet rive.suds t
4.DIttc Well(s)Cori:pieced: 6 31 ciri ',yea.m,-:-/ , 0 ft• 4,2. 15,- 1 my&.....
• 4.a. f:. i goo I make
Si Weil Lantana: '• • i
Asilei 10. ittr'SS re 1
1
traottftytttwocNstac 7..-tity M-..i.‘(iFaniloaltio": a. i a. E-;.r=(--,r:!.\
q8 b.-, 1.Ant., TrAll_it,seofe. i 878
,3
i JUN 1 0 2424
?tryst:LI Address.Cny.and V;
.IctOgsot.)Coue.nv '76717,73-9430 ".
' ' 1E.244.42
1414M ki
Crony ?creel IricatiE=d=No.il-IN)
6b.Latitude
and longitude th degreesiminutie.isecoods or decimal cievets: wkierAllowert PoilC001, i*
i1'well 5eld,one ist/long is suffici=1 11 Cerdacator.:
35° 15. 40 N 083° 05.ID 80
.--. .: e; -
6.Is(are)the well(s) kernaa St ec. .tw cg.
nent or rtTemparary
3y signing thisVarx,1 ierriry arab,:her it.Isrilf:si gus inrr)anorrn.ed ia
T.Is this a repair to RA insisting welt: rlYes or pN. .,,..i.-:is.i NCiC 0.7.c.0.100 gr ISA SC4 C 02C.0200 Weil Coartnirtion Stanian
Tails Ls e rrinftr,j4/74nd knosn nil csaszructiost inf=ovion al'empIcir:;i:o r.64,.r.gpirc ecitv qfthf;,T=Ii jurs imocYr--;ifti rg7 Ii.i 'Veil Q"rgr•
rrixtir=at CU Prroorfer rection or on'the bad-of th:s filo:.
'-3.Site diagram or adtititional well details:
You:soy 3 1:se she back of this page to movide additional well site den
For Geoprobe/DFT or Closed-Loop Geothermal Wells having the s=e
=mod= . nish dditi .
oonernonon.only:law.: is needed. Indicate TOTAL NIP.V.BIER of wells .4..%zils. You ay also atta a onal pages if necessary
Miller.: S Li smIT.T.N.I.INSTRUCTIONS
9.Total rrell depth beiow land surince: r700 at"4 For A.:I wells: Submit ti.....:s fc6-=.within 30 days of crimple:
Ferr:wimp!,..‘var list sit Orptbs if erafrrent ri-x=r4rir-3@200 and 2SIGO) cons:.-scctioa to the followinee
SO.Statio water level below top of casnig: /10 ft•.; DiIts'.on of Water Resources,Information Processing Um
If wiser leurt tr sfrove oasinz.ar--,i- 1517 Marl Service Center.Raleigh.NC 31699-s el
is.Boratiose deter t p Cir..; 7.4t.For iniecdorx wens:. In addition to sending the forrr.to the sit
\Jat- O,c.. also sr-bran o--c copy of gala fora oiaa 30 dor,of ample
12.We construction soon:god; C.A.A-it • ' P ,-,'''‘4 ' A'S cons=alioo az±c fcilowav
V.d.arip:r,rotarf,cable.‘faset Push.c c.)
Division of Water Resources,Underground Injection Control 3
FOR WATER SUPPLY WELLS ONLY: 1536 Mail Service Center,Raleigh,NC 27699-1636
3.1a-Ylaid.Iffna) .2 Method of test
jzi....D : 2.#.•7-For Waz.r S000iv&It.iection Welts In addition SO settliag
i the -..r.dress(es) a-nerve. also submit one copy of this form within
‘..js_0,......,.1 • - .1
13b.Disinfection type: * 1 n A.ZIG Qr.:: ', :,72..L., con:pier:on of well coos:motion to t e county health department o
- . whet consmoctx:_
form OW-1 Nort.l.C.:zroIrr.z.:....o:artr,-,-.:of 11%-M:roma-awl -
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