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HomeMy WebLinkAboutGW1-2022-04059_Well Construction - GW1_20220425 WELL, ea, For a1 Use o L WeU Contractor Information+ L . . 1Z�in e Q,, 14.WAIEtt2:QNLS. wen e0cM=Mx== • 353s 50 �• z�-$ K NeweRCaameoorCadS=g,,Nember R v R FROM feria esfedtiilb OgLaIS[L' .r..?. •_, uJIJ��Via', J J]�C F'h IVA'b�.7� ?ffi� xri•r.o•�r_ C�Name .• R R im. 2.WeUCoasc=doapermir#. �� 2 p 7a—/ r oRa r et�cFml >•. D7Wf��t �AL~•j•ZlsraII�pFlcvbleweII axrmlts l9•a LlIC;Cofray,Smtq Yarimiet ue) '�•�• R R 5 71e in• T�if[� ytI V 3.WeUIIst(CheekaeH use): Wa rftpl]Wdi: :/37 tS8N.�.-.r: ::.yy.• _ asw ,4�.•� :i=:w:�kt::Ste'•:rG,c^T` Agdcalhagl imo DUMXM - S=Sit1; I-21DCtomm wra r*nrar_ M&I kItpi;i]/I Mm, ft ���//��(ge�Coolmg Supply) DR,sdd=fial'Waab!rr SWp7ly(�e) gp R i,� . OIadustriSycommet W p7twc+riMt4A1 Wat Supp-J(bm fl 'pIl .IB.•.GROiIr s.: ::ems .•r••...•a��..•t.; �:..i.Eei..•...•::'y,.: []We11s>100 000GPD FROM TO y MA'�'�ra,_ ':''m1�rdC�YrMStBODhAMauxr Non-WaterS-pRFWdh tins DRecovcty Z3 " -+ Sri DA94uffr [1CuoimdwaterRemtdiatian $ 13Agmf=S3scage2ndRecovMy USaliaitySaairr -19 SANIDIQLIY3LPA d ��rsCx :^:y^+� ?'r• i ::mot FROM IUD MAZPRTAL lMpfAtZal�7rNZERM' C` �T� Osum'xvreterDlaiaage R R CBcpeamemtal TechaoIo�r OSnbsidemne Control R R dal(Qom gyp) CTraeer _ =20 DEIIS.IIIGFA�a etid3di&iid ieel� 2,"'�-�.q,:_. DGeot=9(Sea&&4CoolmSRe�) ❑0d=*P�tmder#21R=adm) FRo R TO $ nzrscaueizox ySew- c - 4.Data Wdl(s)Competed: -2 2 Well 7D# ti Sa.Well Lotafion: - R F /O+,arNeme FaeaityII (ifrppEwble) tr. C=ZW ,� FatselTdeao�eallo.(PIIQ) � ",• 5b.Latitude and Iongitnde in dMrees/mmates/sccands or decimal degrees: (>fVMn5e1d,ox%dJoagis sates) • 22.Certffieafion: IX" +q N :2 g '- 1s'' L& W Z Z � 6:ls(are)the weII �� (s): t�r an meat or OTemporary -F 7.Is this a regait is as �'n�°17s *1 3 tFcrahenrd(s)vm 6mmj aoator=dbi==fim=w&h evstbtgweII: []Sea or 01Qo ISM]VG1CO2C:OIOOor15A1yGIC01C..0200WrdCpras�imt.S7�mdsa�Llnzampy Ifrhtr aabwwMrrIIamnarctlat ®fan Mai cF&Z rIrmn=caofrle ofrLi m=dh=beaiFrmdedsoAcMedorne_ 'Mmt-fer021 sa z*seeganorentheharxofthaforrt 23.Side diagram or add"itfoaal g en details: S.For Geoprobe/DPT or Closed-Loop Geothermal Wells baviagthe same Yon may use the back of this page to ptoHde additional vell com&ucti=info cotuhvctiou,C*IGW--lis needed.7adicAft TOTAL NUNBERofweU& (add'SemOveeiuR=m dmBOXI you may alsoaCachadd,b=2l page sifneany. dr111ed: 24.SUBMITTAL MgSTRUCTIONS 9.Total well depth below land surface: f A 0 (ft Fosnsdnple>.dirt;,:aIIde�da ��v„nC ie_g(�200.mmi2�Ipp) SubmitthisGW-Iwithia34 days-of weUcompletioaper the fallowIng: 10.Stafic water level below top of easing: d (�) .24a.For All WeIIs: Original form to Divialm of Water Resotuees (DW4 I}xmQiendsrci ,rc,�t„� -+- lnfi onProce gUnit 1617M5C,Raleig%NC27699-1617 11.Borehole&metrr. G (m,) 24b.For lhiection Wells:Copy.:;to MR.Linda mt nd Meetica Control(IUC) Pra�ram,1636 MSC,Raleigh,NC 27699-1636 i 11 WeR mmtem iou method:__ O�Lt v» CLtie' (LQ � �eab1Q diadvatb,ctr.) 24c For Water SIIIIp1V Snd.OpeII-IAOp GlOtllerm/1 Rt31II'a WeII�cow to the �•:. county eavatmneumbea"deP2VM=0ttt=CouctywhavemsbWed FOR WATER SUPPLY WM S ONLY: 24d.For Water WeUs producia�over IMOM GM.Copy to.DVAR CC=A 132.Xidd _ d Q Pam I'gpm,l61 MSC,Raleigh, — (EPA Ivfnthod of test: �ti` , 13b.Disinfection type Amount: Foam GW 1' N�athCmoliaaDepattaxat ofFsvnonmental Qm1$y-Dividaa of WatxResomoes Revised 6.6-201S