GW1--06439_Well Construction - GW1_20241101

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LI CONSTRUCTION RECORD(GW-I f For Internal Use Only.
1•Well Coutrador Information:
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Well CauftEdarNam FROMTo R roman rater
ill
ft. ft.
NCWell Cae@agar CatiScatiaa Number Ls.ouBER CAslh'G(Idmilti-uxd Teals ORLIN/31tIrjmA. le) .L
Morgan Well &Pump, INC FROM 7° " D° 'i' t
c, xze
1 IL /to ft•16118 i'•� -
SDR21 PVC
/4 Z, ,O? ,J,7 .FROM SCA.�PGO8T0 IA31 �C -MATERIAL.
2-well Construction Permit 8:f/ (7 (•j C� FROM To ntuarrx _
raj P.
ratan re wen co<t�„ r„fct as UIG Cover.seen r�rg6x'-,1 I ,
P. R is
3,Wed Use(check wrdme):, t:", _1
Water Su •
-:IT.SCAffi'i-.: :.....:i.: _..-.._ _
rely Well: FROM r .:u _ .': � ..:_ICA t.
DAgrionkural OMtmicipal/Public o R le- fOGeothamal(Baimg/Cooling Supply) OReddr�ial Water Supply(�g1e) g R ia. .. Ij
OlndustriaUCommetcial DResidential Weler&FOY( ) nedG>scar:v.:_.....:'- ::3 V:;?':Y3,=i 2 if..i i e c;::i:'.'�. '."
SILT gia O
ad Wclls>100,000 GPD PROM TO -MATERIAL 12g1 CIAONr)¢THOD A AMOUNT
I4 Non-Water Supply Wen: 0 R 20 R- bentonite poured
i, Ohfmit®ng ORecavcry • M R
Injection Well: - -
El/SquiferRecharge OCirca:dwelt:14mediaice rt. rt. _ '
:2.a.Va VALPACtitripplicare)::•.' a:_4=Iti:•:,e"::_'�k; >
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OAgnifcr Storage mulRecovery °Salmi ityBarier • FROM TO MATERIAL Parrucsmromirrnon
OAquiferTest OStotmmterIhaimge R R
O Experimental Technology °SubsidenceCoato1 ft. R
°Geothmaal(Claud Loop) OTtaar •2snanriltGX:00(ittufii am=labi£tilfbailiir7)r,:. .-• .. .....•-
•
t °Geothermal(Hmtin81Cooln6Re6tm) OOther(explainundclf21Ramada) FROMIL � it `�ttlatfuter, 1 troae.il•,fsaa)
4.Date well(:)Completed:r-t1--t-.' __ Well IDp n L 3 ft• ^Cl((( op.cp -
5a.WedLoeation: ft. 7 I R t3C0 1�"ft0C 1 : C u v? ? ..e. -,.,:I
ft Yj n C
5/VO4 6tlfe f ern/cal/rQ�
Fadity/OaroerNamo FmTh»>aCdaPpii ) It. 'n NOV () 1 "cC24
/(02/ co/R/40( LPI^t n - P.
Physical
ft. ft.• )r;f�;,,,i,, ., , - .� '•✓y..
.(/J/1 c°1//y!,End t -23:REMABR3:. :..... :%. _:4: __... . ...e- - _. li.S: ,... :ice '
Cetetty FazedIdrriCatiostNe.(PIN) g
Sb.Latitude and longitude in do eeslminotedsemsidsordedm decimal degrees
Orwell 5dd,one WJioasisaulEciex) 22 •n: '
• s 9.5-26; N g1 Za07/ 1°- Z1*-Z11
, •6.Is(arc)thewed(s): °Permanent or []Temporary eflCoaaxtor Date s
By airlarm Iharbp tat ifythat BzweII(Owa Own)orxr6ededin=anta=with -
7.Is this a repair to an existing well: DYes or CNo ISI NCdC 02C.0100 crett 11C(C 02C.0200 FRB Constriction Standards and that a copy
Vas is arepoirJ lecdlmmm toe/mamvctilatWarne=oadeoplate Me nature of the ofth readlm beenptvddedtn t ewelo..er.
repair soderi2l rmsartrtt oras the back cider faac ,
23:Site diagram or additiomlwell details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of ibis page to provide additional well construction info it
construction,oalyl GW-1 is needed.Indi�eTOTALNUMBFAofwe s (add Nee Over'iaRt�alaBox).Yenmry also attach oddiriwaIpagesifnecessory.
dialed s .• 24.SUBMITTAL INSTRUCTIONS
9.Total cll dejttui below laud Surface: Ctr3 (R) Submit net GW-lwithin30days(dweIlwtnpletiocperthefollowing:
Fora tLlu altlpte tall deptlit Mimi! �1 2Q100)
24a.For All Wells:Original me to Divisim of Water Resomar(DWR),
10.Statieeater ten]below top of casing
7 (R•) Information Processing Unit,1617MSC,Raleigh,NC 27699-1617
81/0er/metit above cosfnym+'
11.Borehole diameter 6 (m.) 24b.For Infection Wells:Copy to DIM,Undergm emd Injection Control WC)
Program,1636 MSC,Raleigh,NC27699-1636
12 well mtis'trnctioa method:rotary 24eFor Water Snooty and Open-Loop Geothermal Rerun Wells:
(te.ag �er,mncable,&capmb.roc.) county tsvunnmmtal health department oft6e county where installed
Ytothe
FOR WATER SUPPLY WEIRS ONLY: 24d Far Wafer Wells producing aver 100.000 GPD:Copy to DWR,CCPCUA
13a.Yield(giro) 5 Method of test:air pressure Permit Program,1611 MSC,Raleigh,NC27699-I611
136.Disinfection type:G aet+led dlnsan Amount: / �v
FormGW-1 North Molina Dgatmmt ofEnsimonmhl Quality-Division etWatcrAmerce* Revised 6-6-201a