GW1-2021-01332_Well Construction - GW1_20210329

" �v"IlaEU�'q RECORD GF)U�l
I,Well Contractor Information: For Internal Use Only:
Chris Morgan
11'ell Contractor Name 19.111.4 ZONES
FROM TO DESCItIPT10N 3572
NC well Contractor Cenifiwdon Number rt. p.
Morgan Well F:Pump, Inc. 16.0UTCn CASRVGfrormWti-cased wetLt OR LINER i[. Ilcarylo)
IROJ1 TO DLIAETER Company Name TrnclwEss 1rA1L•RfAL
�r +t ft. It. 63/e in.
�3 7 sd2l pvc
Ll FyelPlecalConstruction Permit g; 16.INNER CAS1N OR TUEING( eothermal closed-loo
Lisl n(I nPPlfrahle u'zllcwrrtntcllon ae FROM TO OWMETER
r (t.e U/C,Counq.Sfafe,{'orirtnce.e¢-) ft. ft. MATERIAL
3,Well Use(check well use): tt• in.
Water Supply Weil: ft. R• in
17.SCREEN
Agricultural DMuniaipal/Public FROM TO of 41EfER SLOTSIZE
�Ocorhermal(Hearing✓Cooling Supply) [t. [ rn'E56 aWTER
[�lltasidendal water Supply R' m.
4]Ilndustrial/Commercial PP Y H.
QlResidcntial Water Supply
tfmg,ation pP y(shared)Nater Supply Weil: momInO H. ACW1EbT a1ETf10➢&AMOUNT
itoring II--rr'' 20 ft• bentanire pouretl
Injection Well: � 11ccovery
a rt.
Aquifer Recharge []Groundwater Remediation f°
ir.
[,IAquifer Storage and Recovery Dsaliniry Barrier 19.SAND/GRAvELPACIC;fa liwbic)
Experimental Technology
Aquifer Tcst FRONT M
�]IStormwaterDminage ft. TO ATERIAL I, PLACrNISNKr XIETHOD
Ft.
[][Subsidence Control
Geothermal(Closed Loop) ft• rt.
[]]Tracer PGcothormal(Hea .10.DRIiy[NG LOG(attach additional sheets if Remssaq•)
ting/Cooling Return) Other(explain undcrf:2l Remarks) miOat To
DESCRI ON coloq hsN sai0md:1, G amin sire etc.'
•1.Date 4'Vell(s)Completed-- Well n/ z/
d tr
3a.Well Location: 6d ft. crV /W�
—YLI
�(•�
yly i A/ �U S-� n/a 3 ft' n.
F"crliry/Owner Namc !'4,,, L
Facility MY(ifapplirablc) ft. Ft.
1� bGG) os fib sS ,:rdo, ft. ft.
PIY Add ,Cryand Ztp
bw u^ ft. rL p
V`^r 21.REn1ARIffi TS'
County —
Pasccl ldamifiwlion No.(PTNI
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lot/long is suR;cient)
Certification:
IF�3 _111
6.Is(nre)the wan(s) >f Permanent or DTemporary 5 gnalr.`otC Al,year C no aacior �--�- `k
Dale
2Ie this a repair Old
an existingwell; dl'signing thir farm.1 hemba,cent feat f/re ,,I/(J nos("-are)mnrfnrcred is accm dmmc.
Dyes Or �ido ,ri(h I5A A'Ck 02C.0100 ar ISa A'C4C 0?
"'par it de t*r,fall aul 5alfi well constnsrfon Infonlmttoa and Mahafn the nuture ofiha cop'•ofthis record C- been r 15APro video fa die mull Dome'.
C.0_00'pull Con.vnrcFan 9mrdardr and rho'c
repnir corder r:21 raamrkr see(ian Or on the Lack ofthir,(orn;.
23.Site diagram or additional well details:
6.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only I GSV-y is needed- indicate TOTAL,NUMBER ofw.11s consttction details. You may also attach additional Wages if necessary.
drilled. t
9.Total troll depth bean'land surface: 'CJoo SUBM1176L rn;STRUCTIONS
For nadtiple srel/s(isr a!l depths rfdLerera(eranlple-AW200'aRA_2@100'l (f`) 2r4a• I`°r All Ci'ells: Submit this form Within 30 days of completion of well
construction to the following:
10.Static Water level below top of casing:
f ifaler)erel is nbare casing,Inc"+" (ft•) Division of Water Resources.Information Processing Unit,
I I-Borehole diameter: G 2617 Mail Service Center,%leigh,NC 2 7 69 9-7 617
(nn) 24b.For iniection'Wells: In addition to sending the Form to the address in 24a
12.Well construction method: rOtar)f above•also submit one copy of this form within 30 days of completion OF well
(i.e.auger,rotary,cable,direct ptesh,etc.) ConsWetion to the following:
FOR 4i'e TgR SUPPLY ATLLS OINL Division of Water Resources,underground injection Control Program,
S[ 1636 N-72il Service Center,Raleigh,WC 27699-1636
lie.1 field(gpnl) L t-. 'Method Of test: air pressure 24
c F"r:'rater Sunnly&Injection ii'ells: In addition to sending the farm to
13b.Disinfecfioncpe: granular �7 the address(es) above, also submit one copy of this form within 30 days of
Amount: G?6 completion of Well construction to the county health department of the county
where constructed. -
POrn North Carolina Department of Env. Quality-Division ofwmer Rcsour,,s
Revised 2-21-2016