GW1-2022-09239_Well Construction - GW1_20221003

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NC Well Contactor Certification Number 15:0 Gxtcrr Ano`sSea*qw 0a
Morgan Well&Pump, Inc. TO TER mss MATRPJAL
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Company Name (P 2_� 1/8 vo
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-166"
2.Well Construction Permit 41: 7sl FROM TO D THIMMS
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List all applicable waU constrLmdon pvmi4r'rL P-M County,S=4 Prar*mce, M in.,
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3.Well Use(check well use): ft ft
Water Supply Well:
FROM I TO D SLOT ME THTCKNESS TAATERTAL
Agricultural DM:unkipal/public in. I
Geothermal(Heating/Cooling Supply) IlResidential Water Supply(single) ft ft. in
I Commercial Residential Water Supply(shared)
(MOUT..,
I mdrLACEMENT 6D1A1dOUJ1X
Oil I FROM TO
Non-Water Supply Well: 0 ft- 20 ft bentonite• poured
Monitoring DRecovery it. ft.
ection. ft. ft
Aquifer Recharge Groundwater Remediation
ti
Wale Supply ul th.=
on Ty—=OD
lirabre
Aquifer Storage and Recovery DSalinityBazrier FROM TO MATERIAL Bh2L&CEjy=1. 0
Aquifer Test Stormwatar Drainage ft ft.
I Experimental Technology j3Subsjidence Control & ft.
20.'BRMUVG_L0G*' '. - slAtijf'ecd-i*vl.'t�
Geothermal(Closed Loop) Tracer §' i�e .1ft
FROM TO DESCRIPTIO (color,hardness,Sol ek type,V_=si2z6 e&)
Geothermal(HeatinglCooling Retain) [30ther(explain 421 Remarks)
1 9 1 o-ft
4.Date Well(s)Completed 12 Well lD# ILO ft. 3 5 ft
SaAWet Location:
ft
Faci Facility M#(if applic &
or 19
ft; ft
r . j
ical Address,City,emci ft. ft . ur'i:zip'j
County Parcel ldmti (PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
ffwell field,one latilong is sufficient) cation:
Iss.( 30i N 10.339,b VI 22
6.Is(are)the well(s)*Permanent or OTemporary sipa f ,tied Well Contractor
i 6'.' wb -1 the Wen(S) (Were)constructed in aCCDr&=
Z7 s f, I hw cv#5,9
,j C 0.2C.O.700 or I_U JVCAC 02C..0200 ppeZ7 Construction Stand--ds and flw a
7.Is this 2 repair to an existin-welh L71 Yes or JjNo' W
.Prthir is a rqyab,fig DUI known wzi'consbuctbn i6formadon and Erplo:En the nature of the copy ofzhii record has been provided to the well 614-mer.
repair under 421 remarla section 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 well site details or well
construction,only I GW-1 is needed. Indicate TOTAL NUNMERof walls construction details. you may also attach additional pages if necessary.
drilled.- SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 2DO A) 242-For All Wells. Submit this form within 30 days of completion Of well
For multiple wells&I all depths Y'diffErent(az=ple-3@,200'and 2@100) construction to the following:
10.Static water level below top of casing: 35 (ft) Division of Water Resources,Information Processing Unit,
.If'vwfer level is above casing use 1617 1\W Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 24b.For Iniection Wells: In addition to sending the foam to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: f-0"W construction to the following-
(i.e.anger,rotary,cable,direetpusl-6 eta) �j
Division of Water Resources,Underground Thjecfion Control Program,
FOR WATER SUPPLY WELLS ONLY. 1636 Mail Service Center,RaIeigA NC 27699-163 6
air pressure In addition to sending the f6ml to
13a-Yield(gpin) zo Method of test 24c.For Water Supply&Iniection Wells
the address(es) 'above, also submit one copy of this foun within 30 days of
completion Of Well construction to the county health department of the county13b.Diqin ction typ Amount: where constructed.
Revised
Form GW-i North Carolina Department ofEnviromnantal Quality-Division of Water Resources