GW1-2023-00897_Well Construction - GW1_20230120

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OExP--imc,1121 Technology 13SUbsidencc Control fL If.
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21 DRILLING LOG attachdditionalsh,,,birnectttary)
L[EMLQi-_--dcr92I Remarks) PROM R.
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DESCHIPSION S042 h-H-1 l W­k
4.Date Well(s)Completed:] IZI, Well IDN R. It.
5-%Well L ft.ocation: �1 _ icy
ft. I N 116- ILI P
Facility IDA(irapplimble) ft• h.
ft. ft.
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ci�,.Ad Zip ft• ft.
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'M�,A 21.REMA
C--;y Parcel IdWiFc-tim NO.(PIN) Used hardened steel drive shoe.
5b.latitude and longitude in degreegminutegseconds or decimal degrees:
In
22.Ccrli at,*
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6.1s(nrc)the uell(sy Opermanent 2
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or []Temporary c,., Date
-elf: ❑13Ycs or
Is this a repair to an existing% By jignIng thisfornt,I he
0"i'air,fill wdl kwxn m dl mmimVion Info mationandeTplaintlenairoffieq(ths m,a,d hm becti rj,1j t,jj,,,jj
rrlwir lmtder v21 remarks jenrion or an Me back ofildsform.
23.Site diagram or additional well details:
8.For GeoprobelDlIT or Closed-Loup Geothermal Wells having the safric You may use the back-of this page to provide additional%%vll construction info
construction,only I GW-1 is ncWcd. indicate TOTAL NUMBrR of%%,clis (add see Over'in Remarks Box).You may also attach additional pages if necessary.
drill-A:,
24.MINIMAL INSTRUMONS
9.Total well depth below land surface:
r-,mulfpl,teeth 13t atidepila 1fd!fferent(exvmpk-3@200'aitd2@100-) (R*) Submit this GW-I ivilhin 30 days Orwell completion per the following:
10.Static water level below top orcusing: oZO 24a. For All Wells: original In. to Division
"4 UL) I of W rccs Water Rcsou (DWR.%
"rorrWallor,Processing Unit,1617 NISC,Raleigh,NC 27699-1617
I I.Burcholedlaracter: 6 (in.) 24b.For IE[Eq!RLIM:COPY to MR,Underground Injcclion Control(111C)
12.Well coubtruction method: Rotary Program,1636 MSC,Raleigh,NC 27699-1636
0-Ave,-1,rows,cabfc,ditect push.c1cj 24c.For Water S I 1 110 ien-Lao I Gcolh Re urn Weliv:Copy to the
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county environmental lea where Install
FOR NVATEIR SUPPJY Wl;lj.S ONIy: 2.1111. L).Cop),to DMIR,CCVCUA
13a.Yield(gpsn) .r1ir11jud of lest:
program,Penn it ogrum,1011 MSC,Raleigh,NC 27699-1611
13b.M3111rcction IYS,C: HTH Amount: I 1b.
F.".Gw-1 North Carolina Deponent oflimi...mow'd Q-li(y-Division offtcr Resources