GW1-2022-09234_Well Construction - GW1_20221003

Well Co h~ or ame mom TO DESCRIPTION
4
I
-A ft
ft. ft.
NC Well Contractor Certification Ntcmbvt I
' M46isea*eZs
Morgan Well &Pump, Inc. FROM I n. �XI DIaj6ErEkL I I MATERIAL
fL 1 6 1/a/ in. d,21 Vo
Company Name IL L44 - I I.. '
02-111R. I JrMNER aLqjNG 0R.TUBVgTWi6 it 6,34 -=
2.Wall Construction Permit 4: %--) 41 FROM TO D7AMBTER 1 TMCMqESS I MATERIAL'
List allapplicable well construction jomnju'(i a EUa Cowgy,Stale,rarian_,etr-)* ft ft. . i., I
3.Well Use(check well use): ft. ft i30
water Supply Well:
W FROM I To DIAMETER I SLOTSrZF I THICKNESS I MATERIAL. I
Will Agricultural DMiinicip ublic f, ft. in.
P Geothermal(Heating/Cooling Supply) 1IReSidential Wafer Supply(single-) ft fL
--olacinstrial/Commercial QResidential Water Supply(shared)
B.'CROA.-'
b,lui.Ratiom FROM TO 76AXERIAL EMPLA M=OD&AMOMqT
Non-Water Supply Well: a ft 21) ft bent6fte. poured
K—Monitoring MRecovery ft ft.
..Injection.
M ft ft.
Aquifer Recharge [3GroundwaterRemadiation
Aquifer Storage and Recovery D Salinity Bawer FROM TO I MATERIAL EMPLAUUMNTMEMOD
Aquifer Test [3stormwaterDrainage IL ft
I Experimental O
xperimental Technology Subsidence Control ft ft
'Geothermal(Closed Loop)
Geothermal(Heating/CoolingRetam) Other(explain under#21 Remarks) I FROM To DESCRIPTION(calor,hardness,sall/rock tYPE6 grnrn size,efr-)
ft.
ft.
4.Date Well(s)Completed: Well IN 1-5. it 12-0 ft a1� 4i
Well Location: 20 y1belL ,
OkA Z15 n ft L-1 ALA
%.% �1 — 11 .1ZbD & Ubt a rauut,-*-
Facility lD#(tfapphcable) ft.
ft Un;j
1 X'k%UYCI So ts6vmw--Vlq'k G
ical Address,City,and Zip f, ft
0
County ParmlldenfificationNo.gMq)
5b.Latitude and longitude in degrees/minutes/seconds;or decimal degrees:
(if-weU field,one latr1on.-is sufficient) 2 cation:
I q 2 '80 . 2-q- 35 -'W
6.Is(are)the well(s)*Permanent or OTemporary Si MUM Well Contractor Dat6 L
I hereby cer;*that the wafl(s)was(were)constructed in accordance
or.,
7.Is this a repair to an existing welh Elyes or NINO wT17j 15A C 02C.0100 or 15A NCAC 02C..0200}Yell Construction Randw-dr and that a
Ifd4r is a re ofzhii record has beEnprDvided to the well owner.
repair out known w&17 construction information and explain the nature ofLhe copy
repair under 421 remanb secfioyj or on the back ofthisform 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 WOE site details or well
construction,only I GW-1 is needed. Iudicate TOTAL NUNMERof wells construction details. You may also attach additional pages ifnecessaxy
drilled.- ' . I SUBIV=TAL INSTRUCTIONS
9.Total well depth below land surface: PO —(ft-) 24a. For All Wells. Submit this fDnn within 30 days of completion of well
For multiple wells&I all depths Ydffierenf(=mnple-3@200'irid 2@100) construction to the following.
10.Static water level below top of casing. Division of Water Resources,Information Processing Unit, -
..P'wafer JeveJ is above casing use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6. U11.) 24b.For Iniection Wells: In addition to sending the foil to the address in 24a
12.Well construction method: r0+D'YA constructionabove,also submit one copy of this form within 30 days of completion of Well
construction to the following.
(Le.auger;rotary,cable,dirretpusb,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR EWATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
_al L
13a.Yield(gpm) Method of test all Pressure 24c.For Water Supply Iniection Wells: In addition to sending the form to
the address(es) 'above, also submit one COPY of this form within 30 days of
13b.Disinfection typ Amount. 10 ot completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environmental Quality-Division of WaterResources Revised 2-.22-2016