GW1--04845_Well Construction - GW1_20240814

WELL CONSTRUCTION RECORD (GW-1) For Lrceraa;Use Only:
I.Well Contractor Information: •
Russeq Taylor :. 14_ZONES
Wen Cm ACIOf Naze • , MOM TO DESCRIPTION
2187-A I/O ::. lt5 ' 17-Ilib2
•
?ic wau carcsGae cmtifrcstiaa Number i.405 fI ' r/1 o ` a re a
IS.O TLR CASacG csor mat ,MU} LIP=ats11p�td
4 dden Brothers Wei Drilling, Inc mom '.x O DIAMETER 1 CC= 1ttslptlAL
Company Name fr. r_ hr. !
3.Wen CoatCraalon Permit*: a5 15 a 4'' 16. 1I£R CUING OR TQSING(eeather a 1 etowd-..9)
;FR M I TO I MAME= I 3IAT AL
Ulf ell It well re e oa pa mrrs a. V7C Corauy.Stacy Forarcr,ctt;) s. i rt. . 1 la
O 95 to • I38 SST eek,
3.Wan Liu(cheek well use): fr. 1 2 la. I
Water Supply Weil: 17.SCRIM'
Apirobottal FROM 1 TO I DtAME ER SLOT SIZE 1 T7Ie>n+S= f MA1
Mt:aicipal/?t:biic ft 1` ft. is 1 1
G>
_ i�`a="iP & PF1Y) kResideaial Wate Supply(siagna) i 'Sifr. f
FaduaciaUCommetaia! DResiOeedal Water Supply(sihared) 't I
i mOM t TO MATERW. ! zatrL.,CLzonrrbitfROD tR.
Non-Water Supply Well: ; 0 R 1 u, 3.. =az4ev.. ! .,,oro.a
CODA : DRcoovGy !1 faI
�S t fr. I •••
tit t
re-Rochargc `t etoond,2atr N.ocordir.dor.. t
• Storage and Reca r�g IS.SA MI/GRAVEL PACK of aaalietblel
ability' •
ElaA:G i FROM I TO ' SLI.TERLtL 1 mot.0 StsT Stl!!f
infer Tat Os-,a=waar Dreiaage !I ft. 1
Experimental Teshnolo tt 'f.;
€y �Ss:6si.rice Caatroi t i r_
Geothemoal(Closed Loop) OTtacm• ! III.DRILL1 C LOG fssash acidities:I sheets if aesoaary)
GeotherIDtl • oils Rectal) r`Otter(eza lain::tee 21 Rtsaads) jI FROM ' TO DESCRIPTION tether.brdessamaid Moe,odes
I a i $5 ` clay 1.san0
4.Data Wags)Completed: 1 o?A24 well SDe 85 " ; t;op
5a.Wsli Location: !
alarm I nde-6h, ...
teleitytOwiterNaase 7yolk:;.ID=cli'apr.L-ersiei ft. 2 1
I)49c2 Fraser- ,Win I —9 8 r73'.J D.
?bysisal Ad .C y. zip It
1 4 7117:1
fried,, Crw,41 &nai I N31 rl 7.1.REMARKS
Coup y Pored Ide.3tiezatt=No.(FIN)
ifs.Latfrode and rangtmde h degrers/aosautesr ccands or decimal degrees:
(if welt held,oak latIong is mfficiat) 12.Cer &cation:
.36e 09. 911 N 083° al.059 w �.� J a,4r./dr-z__ 1.21404
5.Is(are)the wells) ¢t.Persa:nezt or ETempora.^} 5:3�acu:c ors csgcs wcl(Coar:scm
T+ e{�r Sy signing:ids fano.1 iserrbr col,brat kv ur/l(s)was(brrri owe-m rrd ra
7.Is the a repair to as tang well: Dyes o: il�iNo :,:ti::Sd �C4C 52C.0100 or,S.4 VC.4C OIC.OZO0 Wrif Ceaseaenron S me=
i&Ur Ito r.parr,Jiff era LDonn mil a rrocabe:t:farma:ion T�cpiar,. a:crr a`:irr copy ofrisrs"=flihscr bey Fravided ro the'MU aw,rc,
repair mart X71 mrearltsavioliorr or or the bad'oftlrsfartr. i..Site diagram of additional well details:
S.For GeaprabteDDPT or Closed-Loop Geothermal Wells:,ovine the same i ou may use he back of this page to provide additional well site deer
eosstroetian,only I W.l:s needed. Indicate TOTAL NUbc..3 of wets ecar:det`riis. You may also attach acdidaast pages if ascssary.
SUSk71: Tat INSTRUCTIONS
4.Total wen depth below laud surface: /W° (ft-) lea. For Ali Was: Subm:.:his farra,vithia 30 der of cam let:
ma For /Xpi►wells ail depths iferdre ent(rcaurh-.3cz00•=d 28ioa'1 corsrrce oo:a lac foliowin= }s P
l0.Stade water level below top of rasing: 10 i=`t.; Division of Water Resources,information Processing Uri
(your Is ab01r`oozi uwe-5- 1617 Mann Service Center,Raleigh,NC 17699-I617
11.E°relsole dEaasereer. Oz.; 34a.For iniecaon Wells: I:r addition to sending foe:orrs to the act
above. also sebrs one cony of Eaie fans„-Itbia 30 days of acauplat
lA Welt construction method: i.2 . / 1 cor:so.ce lcm to:he fcllomne
(I.s•aoPr.exam mirk.dem psi etc)
Division orWamrResources,Underground injection Control P
FOR WATER SUFFIX;YELLS ONLY: 16336 Mail Service Center,Raleigh,NC 3 769 9-1 63 6
13a-Ylttdd(gpm) l V Method Of Lase- L.YtiL KJ 24e.?or Water Superb&Iaiectsors Wells: In addtSeo to semd4.ta
�. z ; the add:rss(es) above. else submit one copy of this foes within
i3b.Disiatecaoa type: 'Ii l amoi:i,: t (g ciai, cc: piedoa of well cons:astioa to the county health depasstreat of
v were consntse'ed.
Form QW.i W..Cato::a Ce7srn--zcc s::.-,tra .�_;!zy-TJ^.ror.a Ws.:.: e:i.z s RC:i
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