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HomeMy WebLinkAboutGW1-2022-06413_Well Construction - GW1_20220603 �r�r,eoxIIeriox x�ea r For»Use only: I.WeII _ n vanC*cM=WName f==, PRObf NC Well Coauaetor Certificadmnmmoa ft g 7SUD7 (?A.S�1G weds OSI�t' ::n._•_. I—YYa ECM TD •D7Ab�g �� ���� C—psayName IL $ is 2>WellConshvctioapermip#.. � D LGroII apptf`vEle reII P s eY a LQC Cerraay,smrt Ymim ce,ate) .�, fi R .XAbEC=m, •� 3.weul?se(ehakwell mer .s., iL m Th 1Water Supply WeII: $.,QZ=Sf .... -a: :� :-Y.�.� Q14g11CnitSII$t eft_`_,,.. M 70 D Q scars= O V177➢fIT 13bdustSzVCa==dd(gr�inyJCootnig SAY) g ft. •3a. -O eon OWeUdendal ater Supply( .I8'.GROTTfc.: <';ty. S�: ��1_�} ` :•: : NIoa-WitrrSappl9WeII: EOM WD R �D 2TAC•XMa�rr o��w�omrr it ' t2M QRecovery � $ � Injection WeIL• riA °AgoiferRecbazge °CicaimdwaterRemediatian - $ � 0Aquifer Swwge eery QSAUVftyBaaier OAgaifrrTest FROM TO sR119QTAT II1�ACII�@lrI�9D QStapmzvraterDramage it R � 1 Teehaatogy QSnbsideflce Control g R C e (Qom ) QTraca p ?7A.`DBILLIIZCrFO�' a�tise3additramaLihi=b'if ;�,. � ;�..,•. ( CoolmgRcmzn) 0 O&M( under#21 Remaft) i $ zo Dt oN aslh�dc ~am« 4.Date Wells)Completed: 5-Z6 •ZZ. 'W�D?# !G '' 5s.Well Lotadoa: & fL Faabty/O,wmeN®e Fac7apIDd(iifgp&aWe) 8 S [ CD ' F Fr�cdH,,..L» , A/l� i �;,�. � P*sicd Adder CdS:so3Zv , it COUZCCY Pa¢elldaaNa(PIli) , icy 1 t`is l it 5L.Latitnde and lo L"ryy„"i(;; "'SCE.srw,l- ltt t>�t degrees/mm�/seecnds or decimal degrees: (:fweu SeId,e+oe Lm7oagis s =Cerffi:� 6.Nan)the well(s): 130ermaaent ror OTemporary /3 S0 sippatme ofCaffib& en` Day, ' BY•+fbzss*lo-;Ilaa*cv*thathe el(s)vwf%cw)eoamrase,3niacmvri W,,4& 7.IsthisarepairLosneeaftweMm C06 or &lt� ISANCRCOZCOIOOa�ISdNC.iCO2C.OZ00lYeaCgasrarailonSaaidm�ismada�aoaopy IjrldTt:vsgufefiIIasabsMMvTllaoeaa�7atbyLaa�m+msalespdansiluismoeoftla ofthitrrcmdlaaLmtpvvvldedmthessr�ainsrr. trp�aradeifll�missaxon open zbebxkoJtldrfoiaf 23.Site diagram or additional well detatk: S.For GeopL+ UMPT or Closed-Loop Geothermal Wells bul4gthe same You may use ttie back of this page to protide additional atll omftc&n info ooashvaroo>arty1GW-1is needed.7ndicheTO3'ALNUMBERafwells (add'Seeover'iriRUnfaftBack),You may also att &addbmdMsifnecemy. dtIM 24.SaBMrzTAL RMuCnONS 9.Totalwell depth belowlsndsarfaee: Fosaadnpte,a¢TMreradgadalefficon(=;Wg@200>md2@zM (� SnbmitthlsGW-Iwitbin30 days often completion per the faliowiag: 10.Static water level below top of ems: I Z O 242. For All We%: Ongmal f�nn to Division of Water Reswases(DM)6 7},.�lewetsra�oNeomrtng se +- c/ ( ) 1a�IIonP==ingUbk 16I7=C,Ralerglf.NC27699-1617 1L Borehole t>rameter. b (m,) 24b.Poi 7aiection Wellx Copy to DWR,Liadetgiamd bg,,ticn Cowed WC) A Ptagrdm,1636 MSC,Raleigh,NC27699.1636 •. 12.Welt contraction method: � 24c•For Water Sa sad O I Loo Geothermal Rama WeIIa: , CLG9> daeetpasl�,eoG) Copyto the .. county eavavnmemtal health department Ofthe county msts"ad FOR WATERSU.PPLY wEi i C ONLY: 24d.For Water Wells mvda'Permit Ptog�1 I1 MSC ours I GM.Copytc.DWR,CCPCUA (EPA 13a.Yleld lVlstitod of test: ,Ralei C 1 11 13b.Dbia6ection type: Amount: w poem GW l' Noid►CarolmaDq>aofFsvnonmeoml QoalitY-Dividon of WsasrResaiaees Revi�ed662018