GW1-2022-08530_Well Construction - GW1_20220906

'/�` •14:.Wl.TER ZONES
` CE or F220M TO •DFSCPJFTION Y
well Co for am To, -A
tt ft
NC Well Contractor Cm ifcation Nurobei
` IS:OD�E•R-GI�SING,(focmnlii rase3vtells)0F2L'7 S 'licahle)'-1. ::`.:.•: :".:
Morgan Well &Pump, Inc. FROM TO' DIAMETER Tmclai SS nxnzERu�
Company Name +1 ft ft 61181 in' sdr21 pvc
J� //j� 16']SII�R CASZPTG OR•TQBIf7G.' eotfierma'I cldsed-166'
2.Well Construction Permit4: / {"\ FROM T'F.R TO DIAMF THICKNESS MATERIAL'
List all applicable well consiruciion p (r.e.WC,Cowrie State,Yarfance,etc)• ft ft u
3.Well Use(check well use): ft ft. In.
Water Supply Well: 17.SCRffi+T',::: - _•°_ _ �. .:•,TrIA1•AT
FROM TO c:.'•.DUiMETER~• SLOT SIZE ,.TFRCKTQESS ERIAI.. •
Agricultural �MunicipaUPublic ft ft �-
i Geothemral(Heating/Cooling Supply) Residential Water Supply(single) � " � in.
I IndustriaUCommercial J Residential Water Supply(shared) ;;78:GROIIT•.:. ':: = '::--::`'":�`':'.::`-'.-- •':'~: :.`=^:;`•�•��.:•:�•::-"-:: :
Ini atiOn FROM TO ,MATERIAL - EDZPI�4CEMENTMETHOD&9MOIINT
Non-Water Supply Well: 0 ft 20 ft bentonite. poured
Monitoring K3RCGOvery fL ft
snjection.Well
�--} ft. i
Kf t
_I Aquifer Recharge Groundwater Remediation -
� %79:S210/GRAVEL'Il CK rf a'IickSre) _'':; . .:'.',`'.:
'Aquifer Storage and Recovery 1.=_7'Salinity Bamer FROM I TO MATERIAL MaLACF&OWT METHOD
Aquifer Test 11Stonnwater Drainage ft fL
1 Experimental Technology Subsidence Control ft ft
Geothermal(Closed Loop) 13Trarer DRTISBr'GS OG'(zttacIi addifiorisI sl eefs�f recess"�' 'i'=.I -_'•.` :--`i=
r Geohelmal(Heating/CoolingRetum) Other(explain under#21Remarks) 'EOM To DESCRIPTION(colo,hardness,so7lrocktype oxnTn=uP ere)
6 .
4.Date Well(s)Completed: 1 LL Well I m ft. ft.
.--s�a.'Well Location: f, it Y
Facility/Owner Name Facility ID#(if applicable ft fL
�ta,J � it. r 0 ,� ��22
Physical Address,City,and Zip fL
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(rfwell field,one labbng is sufficient) 2 er cation•
. 6' •N 51b.(p (c W ,5 22
6.Is(are) he well(s) CPermanent orITemporary Sigma eyf7ad�well Contractor D
B o ungm, herelry certify that the wens)was(were)constructed in accordance
7.Is this a repair to an existing well• 0Yes or NNO wulr ISA1 02C.o100 ar ISA jVCAC 02C:0200 Fell Consh-uction Standards and that a
Ifthis is a repair,fill aut Imo wn well consh ucaDn idformation and explain the nature of the copy ofAis record has been provided to the-well owner.
repair under 421 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.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 1 GW-1 is needed Indicate TOTAL NUMBER'of wells construction details. You may also attach additional pages if necessary.
drilled' I SUBMITTAL INSTRUCTIONS
9.Total well depth below Iand surface: p 35 (fL) 24a For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ffdlferent(e =.ple-3@,00'and 2@ 00) construction to the following:
10.Static water level below top of casing: %4!5 (ft) Division of Water Resources,Information Processing Unit,
Ifwater level is above casino use"+" 1617 Mail Service Center,Raleigh,NC 27699-16I7
11.BorehoIe diameter: 6 (in,) 24b.For Iniection Wells: In addition to sending the fonm to the address in 24a
_1 n} f above,also submit one copy of this form within 30 days of completion of well
12.Well construction method; CO I. LA L` construction t6 the following.
(r-e.auger,rotary,cable,d rectpusb,eta)
Division of Water Resources,Underground III ection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 2769 9-1 63 6
13a.Yield(gpm) Method of test: air pressure 24c.For Water Supply&Infection Wells: In addition to sending the form to
the address(es) 'above, also submit one copy of this form within 30 days of
113b.Disinfection typ Amount: ✓S nZ completion of well construction to the county health department of the county
where constructed_
Form GW-1 North Carolina Deparbnent of Environmental Quality-Division of water Resources Revised 2 22 2016