GW1-2022-08987_Well Construction - GW1_20220919

For Internal Use Only:
�lE_ CONSTRUCTION RECORD (GW-1
1.Well Contractor Information:
14:NVATER:ZONES--"_ DESCRIP' Ni
Morton FI10Ni TO
Well Contractor Name i
ft. ft.
2953-A
1'S.OUTCR CASLNG•(for-mdlti-cascdlwclls ORFLCKNESS a lIN1ATERlAL
NC Well Contractor Certification Number FROd,I TO DIAMETER.
ft. ft.
Morton Drilling
Company Name n /� FROMNF.R CASINO"OR TU[i1NC cothernial;closet ES IA .
FROM 'r0 DL-\METER' TIi1Ci( ESS� n1ATER1 L
�J (JV ft. �Jlft. in.
2.Well Construction Permit#: V i
List all applicable rce11 construction permits�.e.UIC,Counq',State, Variance,etc.) ft ft. in.
3.Well Use(check well use): 17.SCREEN ,
FRONI TO DIAMETER SLOT SIZE TRIG \ESS MATERIAL
Water Supply well- ft
_ Municipal/Public ll/
Agricultural in.
2esidcntial Water Supply(single) tt rt•
Geothermal(Heating/Cooling Supply) `
Residential Water Supply(shared) _:18.,GROU 1''
industrial/Commercial rROM TO MATERIA EMPLACEMENT N7ETIl0 s nn�ouri
i Irri anon
ft. ft.
Non-Water Supply Well: ft. ft.
Monitoring
Recovery
ft. ft.
injection Well:
�. Q m
Groundwater Reediation $9:'SAND/GRAVEL PACK(rf t "licatble F.111PLnCF.NIF,NT M TROD
Aquifer Recharge /
FROM TO MATERIAL C 1 N,
Aquifer Storage and Recovery Salinity Barrier ft.
ft.
Aquifer Test DStornwater Drainage
t-I Subsidence Control
rf. rt.
Experimental Technology IJ
;2a.',DRiLLING 1 OG(attach additional sheets if•necessarY) "
Geothermal(Closed Loop) Tracer FRONT TO DESCRIP N(COIOq h dress,sOlVrack t' c rain sire etc.)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks)
I D {t• ft.
ft. ft. ; .� G /4-
4.Date Well(s)Complctcd,5_17J Z7 y Well ID#
5a.Well LLocation,
F� �, ft.!Y�/lf*K t't. fL C
acility/Owner Name Facility ID#(ifapplicablc)
Physical Address,City,and Zip
2l.-RED4dRK5 (`
Carteret —
County Parcel identification No.(PIN)
Unit
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one ladlong is sufficient) 22.Certification:
'60�fit, A/� � -
r]�L
Sigrigai"kg
of Certified Well Contractor`• Datc -
6.Is(are)the well(s) Permanent or Temporary - .
Bp this form,I hereby certi/i•that the urll(c)was(uvrv)ennctructed in accordance
7.Is this a repair to an existing well: 0 Yes or No u'hh-tsd AICAC 02C.0ro0 or JSA NCAC 02C.0200-NreR Conelruction Standareb and that a- _ -
!/J7(s is a repair,./i//o,d known well Construction il!/bonalion r etrpla/n the nature of the copy of(hia record hac been provided to the.yell owner.
repair under 421 remarks smdon or on the hack 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 G_I is fipgded. Indicate TOTAL NUMBER of wells construction details. You may lso attach additional paves if necessary.
drilled: SUIiNIITTAL INSTRUCTIONS
9.Total well depth below land surface: � Z> (rt•) 24a. For All Wells: Submit ithis form within 36 days of completion,of well
For nurltiple wells list all depths ifelier'ent('example-3 a)200'andd 2@100') Construction to the following:
10.Static water level below top of casing: 19 (ft.) Division of Water Resources,Information Processing Unit,
lflvater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
l I.Borehole diameter: (in.) 24b.For Injection Wells: In addition to sending the form)to the address in 24a
12.Well construction method:
/I�frl/—r p'�2 above, also submit one copy of this form within 30 days of completion of well
/ construction to the following:
(i.e.auger,rotary,cable,direct push,etc.) � I I
Division of Water Resources,)Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Centel-,Raleigh,NC 27699-1636
I
13a,Yield(gpm) Method of test: 24c. For Water Supply& Iniection Wells: In addition to sending the form to
a -oy the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type:e *X W— Amount:1 10 completion of well construction to the county health department of the county
where constructed.