GW1--04840_Well Construction - GW1_20240814

WELL CONSTRUCTION RECORD (GW-1) For Liar ai Lse Only..
1.Well Cont-actor information:
Russet!Taylor 14.WATER ZONES
Well CocCtwotxara FROM 1 TO : DeSCRrraOT
2187-A 7? ' ; (t ' , 83-88 115-1a n
xc wail Coma=Cantificolicom x®ber g.9 f' 1/of ,?-,5- d 47-•?5a
m otrr=CA5 G ttar maicl.mrsa was}o&x.IN=fltt etel
Fledden Brothers Wei Drilling, inc FROM TO i DrAbrt7'ER I r�ac,o ifrtTfRtr16
yNC= 1
ia.
16.LNNER CASING OR TIMING(reathamal delead-cop)
I.well C?II/CFRO tD11 Permit t 05 0/ao?-P FROM 170 1 DI NIETEA I TER I UMW.
tern all applErabir aTQ eaasa'aauon permit:(La WC Camuy.start.irarenre,tiro; a 't. ! ?to
R' I
CY In, I f YC
3.Wail Lin(deck well use): _ 7(P it. I! 18 Z ! 6ill. i . 18 8 5 TEE L
Water Supply Welki ! 1 SCXEXV
Arieuiroal i foalI To Du+tax sursta ! moms Stn1
rivaicitaaJ?ubitc fa ! t. I I
Geotb.smal f �eagr'Coalag Supply, 50R r..i esidai Water Supoiy;sa '•'—gie)
ladustriana=tn-cial Q,p.di:...- Watt Supply(shared) •
nlmr on i f rr'
! FROM
Tom'@ 1LlTERLtL For]'I..IGn.InT SFEiRQD a
tNan-wails Supply Wall: I 0 f- I za 2 .....,:aa> ! =mod
aisdoetitozinAction gill; ORecoverry •• h ; ft_
rim q ifa;P. go COO.c:adwar Remr%nZo.. I' ... ::.
S i 19.sAzerORAVEL PACK(if a*pfieablel
:Aquifer Storage and `''~7 :_Saiiaiy Barrim ! FRom 1 ~v staTIORI L not.A.emzernotil
tiAvifxrTrg OSto=waarDrair:age II ft. V
riEager I Tecisnotogy OSubstdence Conn-ol i!—
���GZtWl(Closed Loop) race i Z0.t3RIL1.1\G LOG fatetch addition:I slues if aeewary)
InGsothatmg a tC11tlaglCooling Retua) mOl (e:csllain me.=511 Z�7�-c; j FROM -7 ` . D6auFrso\tmlar.Rudaai satltnet type a:na s
! 0 / car&sand
4.Dato Well a
c)Completed: 7 ,tqi �� 6$ ft. i 300 orar4e
U.well Location: '
PalPia
fa h' � Cho+inc =acliry u'7-(rap-:•cede; ;t. .t.
Lai-Silo Back m+n. /64• A,,g//11 o?87t.34 2 2
°h7sion Addeta.Coy..- Lip r rt.
MA COO eTy (9597 Bay4�D r..RE�fA13IC.S tie
Casey :.:cell:daacL..ta...No.IPLC)
Sb.Lantana Sad longitude M segrecstausutesiseconds or decimal degrees:
iif welt geld one Ivoag is sufficient) 12.Certification:
. ' l 4. G 710 N 085° di. 449 w ,u/.?.4.e..0 J ct.Al.
6. "in_ 45Zat
Ware) wells} ertaanen.t or rTemporar; St cut of Cu—ailed Wctt Caatraeo /
ttf��� 3y sgrirg ads jot 1:tcrrby arty:iwt kr urt7(si ucs rhrrri aadcaasd is
7.is tad a repair to an esdsOng well: riYes o. !o ,,:ri:iSd NCrC 03C.0100 or L 4 SC.rCale'.OZ00 Trill Caaraardan Staadar+c
PAW'Zr a tracts,/Nod bin»sr mil c�rasa:tior.arfa-nra:ian eexpiain car raaaa ar COPY ofti rreard its bee pry zded m ire urli 0 17.
repair andar Al rpmta*sartcon ar ca the tic:*afdcsfara..
13.Site diagram or additional well detour:
b.For GeoprabeiDPT or Closed-Loop Geothermal Wells raving the sz:ie You may:se foe back of his page co provide additional well Site duo
conttntetiaa,only Ir.,is needed. Indicate TOTAL h'U MBR of walls znstrttcdoD r�rifs_ Yes may also atuch additional peps if atcatary.
dralM:
SUBMITTAL INSTRUCTIO%S
9.Todl.yell depict bdaw land surface: V 00 (ft.; 24a. For Ail Wells- Submit this fc: wit:3M 30 days of completi
%ar mple write inn Sir d•pt&s ifdfffmmr inavtds.30,200'and 2gfcol
corstruaioa:o sec following
10.Suds water level below top of casing: (JO ;.t.) Division of Water Resources,Information Processing Utti
Xwassrr dewe is ahO1aeasing,:as,-_- 1617 Mail Service Center,Raleigh,NC 17699-1617
11.Borehole maaseter: 1st (ta.; 2417 =or inieccon Wells In addition to send og the iiorrn m the adc
n ' L —Th.�l above. also sabrait one copy of:his fazm .idS. in 30 days of evropla
13.Wel1 con :e csioti mgrbod: `�LJ Z. 'LIIZ 3~.,i consatc;:oa as the following:
Ct+•ate.:sassy,cable,cretin posts.GLi
Division of tinter Resources,Undergroued Iuecttoa Control P
FOR WATER SUPPLY WELLS ONLY: 1606 Mail Service Center,Raleigh.NC 2709-1636
13a.Yield(gpm) )6 33ethod of test &t.lbe J 14c For Water Suomi,:&lnteetsan n allg in addCoa to seeding
In I 'Me address(es) ahave. :Ise sub.-nit one copy of this fowl within
13b.Dialaieesoo typo H Dian: t IIcrAIJA. ; catpleoon of well consmemian to Me county health dapssesteat of
Focus QW-i No.-&drat a 1po-.-"t of ytroomasua Qom.::. 'D^.roc of W.:r.-Reso,ao.o 3 vt