GW1--05382_Well Construction - GW1_20240909

WELL CZ2NSTRUCTION RECORD (GW-1) Far intertai Use Onjy:
I.Weil Contractor Information: -
•
Russell Taylor
i 14.WATER ZONES
Wan Cosa=Nose . ,....____4.. 1%-"' 70 , DESORITEION
2187-A !1044 Ito ft• , 18b-18
a5
xcvidica.n.t.c.e...k.Number 0 ." 1 S95
:.ate.._._:.:07TrZR 4...Asev :mm.4=4
H ox
idden Brothers Weki Drilling, ric i m TO i MAME= . mom; MSTIIMAl
Caspar/Nome
CASING OR TUBING famacheasi eicasihiesal
I.We ConStruction Permit#: AN-414408-9- k3/P93 . .-.IT TO ! notrrat -mum= I HAM=:at ell spiles4le inta cettersctlan permits(La WC.County.Slam.7orforst.ow.) l' 11 ft i 16 4 ft 1 L. 112, . 188 '1/43-reei
s---..._.-
ater Supply Well:
SCR
iW
Aphoolooral Ddr.micii?t: c 11 17. IM-
i MOM I TO
1 fr. I
'
D
alatisarmel Camosillip'Coarsaya Supply', EResideonia/Watt Sliroply(hinsie) 7----77f, i
httbscrial/Commereial .Res.:6-14=I Wa-=Supply(share3) '•-•-i-
13.GROUT 1 nustEr12t ! SUIT Sta i T1114:311133 1 Md
1
ft.
. •
rikisiti= . . FROM ! TO ' NIAMetL4L 1 urn.A=Errrarinooji
Non-Water Supply Well:
0}01 . •
DRocovery 1,
f•- I ft. 1
:sec Recharge 0 Ciroundwator r,.=e-iiinior. t: '
19.SitaIGELVVEL,PACX tif sooraable)
• Sp and Raacivary r1 MD
Salinicy Ba.-ic- Mom ; To ' sUalr:ItrAL ! nex_srporrr sal
atter Tea inStannwams Drainage ft. I 2. ;Expaimagal Ter.kno/om, ''''S,-i: --,- 57....Crite Control
Genthemmal(Closed Loop) 'Mime= ! It oPT TING LOG(emelt additional shorts if nedesaary)
ega
_-Wte:i -0 ttle=g • 0 Renttn) Other Cezalain oad=-al Xerasic./ -FROM TO ft. Dclayar:t`21".h"1"` 1"
"44.1" .mdl
0 1 '
4.Data Weil(sl Complexed: 8 war.,t, . 94 l'• 615 2.
oracle
ft. t.
in.Well Ltientinn:
_.• ' le-
Jock 3nlike
resdlityiDwnerNaine o2cslity mi..:chrzp-gieUle'r ft. 2
SEP w S 2024
1k.3 Johsts eiree.x_P_d. C-uilowhep 48743 .
- .
f fr. . ..
...
Pal Adams.city.valc zip
, ,..s..,..-1 unit
jeitNeSo.) Czutrry 75as-0D- 39902
County .....trel Icl=tif=t=No.;?lit
5b.Latlimbe and iOrigittldtc degrirnsiaiaures4 seconds or decimal degrees:
lir well del one istioog is soffteieM 12.CerdEeation:
36° no. 99 I N 083° 04• 7q-.2 NV 2,2t<aAgile.....1;._...7iioez„L.4.. Bifitpi
Slgisons oftunted Wall Cv•ii...4.
6.Ware)the well(otkernsenera or nTemporary
r
3y signing this Amu.I Pere*tat:Mu 40 meats/,oer(Two)osommtr-mi la
7.It this a repair to ea emirlitg welt: Mlles or pNa .,-.'il:ai A-CAC 02C.0100 or iS.4,VCAC 03C.0200 Wril COnsliOttoa sesiere
!irk&lz g rirch:flu out known 11.7t7 conanruction infirwsvion ch=ploin air r.00.ro af 1hr CO 'e:hr;"Cvni;127 I'm=Przmded to mg Intl/onife--
repair order til rentaris ovation or co the back of rtz.:7 fon:.
22.Site cis or addirioas1 well detsuls:
IOU=ay US;Zile back of this page co provide additioaal well site do
3.For GeoprobelDFT or Clo0ett-Loop Geothermal Wells il aviln the se
co ronstruedoa details. You may also attach additionel peps if aseessary.
1 mmotion.only I OW-I is needed. Indicate TOTAL NLV.13Mi of wells
drilled:
sualv27--FAI,rNsTRUCTIONS
9.Total well depth below land sa= tp1/5 cf.z.; 7.4e. Far CI Wells-: Sift this fort within 30 days of ceninplati
Per trutitspIr wells rut ell depths i_terriirrni tiocaridg--3@.200'Good 28100') cons.r.icica to the followii=
10.trade water level below top of=stip 1 0 .,1-,.;. Division of Water Resources,information Processing Uni
(warm/rye ir chore casing.an---:.-
1617 Mall Service Centro',Raleigh,NC 17699.1617
11.Borehole diameter: LP ctn.; 14b. For'iniecton Wets: In addition to sending the ft=to the nett
• N J1.... --..\ above.also seawall one copy of this faros wittlia 30 drys at'caroplso
11.Well construction austiod: 1..j.1• i La..I.Ct.r‘..t. constrzsdan to the following:
C""VA MarYt Cabir,&tot posa etc::
Division of Water Resources,Underground Injecticrn Coon-el P
1 rott WATZR SUPPLY WELLS ONLY: 106 Mail Service Center,Raleigh,NC 37699-106
&c/o13a.'Yield(wpm} JO Nietnod of rest • 24..F.,Now.,guop/v Ai;election Winn In adernion to sending
! the addressies) =ave. clso sabrnit one copy of this fa= within
131s.Disinfection NT= kl"'T_ t I-1 ,..4.2:touritt i con:Fitton of well ;ohms:clot to the
catmty health deparastent ol
where eonshucted.
Fee=Ow-: Nora'lla.ult.tDrnarr-.-...zni.of F.c.-ir.ontrzina.Q:.:_ift.2.•-Ode.of NVOICT.1.3061:C.= RiNi
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