GW1-2021-00642_Well Construction - GW1_20210326

WELL CONSTRUCTION RECQ (GW-1) For Tat Use onty —
L Well Cloatractur Information:
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WcIl C«ameoY Name � - sons ro
O $ O $ . .'.:..
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NC W��e➢Crnoacas Ca+Scffi Nwnbr MOUMCASM 'rim�eidr OR Tam -
(\LPIAlriTt�J is - �• l>maa 7o ales�'a �®s .�•,• ••;..
$ $ n
Compmy Nome ^7
/�� I&Re1�CASB4GORS[IDIl9G ,_-' ..'. . ,'.�;?,•,.=•.rTr .._
2.Well Comtrceooa Permit Y: rlmrot 1'0 ate 'EUCEMN 1 toms"..
u>aaa e.rB aertmaoa/an (u ttlC,Cvmay..4a,u 7�mr�eci $ ,'l3 R 5rl! m /CA. w
3.Well Use(check well ox): R R is
Water Supply Wdl:
PRM 7a aiA1R!'!9p BRrt� 'l7�� vavmr.r
CAquxtbmsl ❑Mint el(Public R R a.
OCmfficumd(BCXM*Cootmg Supply) Water Supply(single) R 8 ie.
OI�ffial/Commaemi 111�Rmdm6al water ShWlf(sbmed) -
9 Wdk>IMMO GPD I I MA23MAL :.:.:". ttR1Al�Dafrt�OD adafOOw!
xos.water Sappy Wm: R R
Cmm mrmg - OReeavQy $ $ �,
Injection WelL
R $ ►Is„
OAQatra .00awmdama Rrmediation
S39.SADID/CdtAYBGPA -, '+;_.^ BMA l 39<..W-
OAgatfiT Strange aodReowery OSalmity Heiner - 110tt 1D v.•aewr.r ttrttemmertormea
OAqudeTest - .0ftrurwaterEmimage $ R
OTscpUCEMCWTetlmolou oSobsdena Control $ $
OGmthennal(Closed Loop) cnr ''20;DRUAZ%LOG amedia&semi"sb&Mff �-`_--""."."rx
DGeotbemal(Hwtm#Coolmg RM=) 00thcr(oplam,mdertl211t®ads) "mM TO a>s r aaf.ea+n.saramae)
$ 8
4.Date well(:)Completed: 3-Z3.21 wa mg $ R
5a Well Location: 8' $
+w*ty/Owa¢Neme raeT¢yMOor sic") a. $ .
Phy:ialAddaat xy,®dz,p a s
4kGlen".) n: ;sing nl
county 0 Paazl mNa"4)
Sh.Latitude and bide in degrees/miamWx ads or decal depe
(.£wall field.am kUl q n su iamt) 22.Certification
36 ' ZG Zx 'N a l ' � ' l�F a
C.Is(are)the we➢(s): Aermanent or OTemper2ry ShenfCavSedlPeIICteeaeh[ Dare
' ••J•rl$�m���r�.I'�^J C�'llIIfdC e.ry..)#os l'•••y.'W64i@C P YpT�IIC v2
7.b this a repair m as e3ir n wed- .Yes or Al. 15ATTi4C 02C.OIOO or 15ANCAC 02C-020O Well Comovmt Soadadr and din a mp
IJdcr taarq.m,ftl aebvr+rdl®maNmarforaemmtmdegda else naave.fdn aJz6is,. hmbmep�vddrd d.,. o9.,
,epab vdv ell,mmb xerlrn or ell dz baatafddsfarav 23.See diagram or additional well details:
8.For GeopobdDPT or Closed-Loop Geothermal Wells having the same You may use the bast of this page to pcaide additional ae0 maffimtim mfo
oovsmstian,a*1GW-i is needed- •Iamdte TOTAL NUMBER ofoell& (add See OveeurRemmb Boa)Yon may also Math addro®l pegesffne=zay
drMed: 4 24.SQBm TEAL IIibTRUCTLONS
9.Total well depth below Ind narfsce: 20 A) Submit this GW-1m30dam ofweDrn completion the following.-.Ur1 +ddgda,JAJBv (e TL-3@M0'ad2@1W)
10.Static water level below top ofc �[J (it) �- For All Wells: Origmal firma to Division of Water Rmaas (DWR;
Y��udbow •�•� Tvfi�atron Ptoee�g Unit,1617 I&C,Ralcigh,NC 27699-1617
1L Borehole diameter. 'C .) 24b.For Inieetioa Wefts Copy to DWR,Undcgwmd 14ec:um CcmnW JUC
Program,1636 MSC,Raleigh,NC 27699-1636
IZ well romRxtiea method: 1�D ka 1. .i /-F�'"
(.a' .�k dam push,�) 21e.For vum and Oaea-Loco Geothermal jwe rr WtBc Copy to th
county mvamm�Kevin ar�,�of me roomy where amaitea
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells rarm in¢over 1("M GPD:Copy to DWR,CCPCUe
13a.Yield(gpnQ Metbod of test: 0- Puma Ptopwa,1611MSC,Rakigh,NC::7699-1611
13b.Dismfrctloa type��� Amoann �1� ''-
Faoa('A'-1 North Carolina Deontmmt otfavm®md QmlLLy-D mn ofWtor R� RCMAd66-201