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Home My WebLink AboutGW1-2023-02158_Well Construction - GW1_20230306 . • 1 1.W OntracTO;Cc- n: ' 1 . . .., . . . •14:NA.X.W.ZONES•:". 7 .'.":.: i :..:',, .i....."::".•:" .,....•.....--,.I.: .::.:: -2'---- *: Well Co! stI.Tme . • • FROM TO -DESCRIPTION •. 1 42z -A • . . ft ft. ft. ' NC Well Contractor Certigcation Numbet • Ik ."IS:0 UR:GALING1(ioi•ninitidiseavells)b_RIslIDZIt.(ifaji lir.$hteyti::::'S.:1"•."•; • Morgan Well &Pump,-Inc. . : FROM I TO- D/AMETER , TEaClu'NESS MATERIAL • . +1 ft• 511 in... ft• 6 1/8/ , 7 sdr21 pvc Company Name ' . • . 16:1/VER CIEDIG OR...111±02V.rVe6Sieniaal.CIO'skl-lo-0).1.:.,'..''''...--'-1:-;f'''';.:'''•... 2.Well Construetion Permit#: 31 061 L, FROM TO . DIAMETER.. THICESIF_SS MA.TEItTAI; . . List all applicable well construction perinits(e.ESC,County,State,Variance,etc.). ft. ' ft. •3.Well Use(check well use): . ft. ft. in. . Water Supply Well: • . 11--BeRmal'.:.-:..::.:C:--. •••••,.•-,-1•:•_•,-.--:.,...*--r:.•r-.1:-.:::•.-.-j.,.;*-::::::::,.:.7-•:-',.:::.:.....::.' .:.- FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL. Agricultural . . Municipal/Public • • ft. .ft in. Geothermal(Heating/Cooling Supply) •Residential Water Supply(single) ft • , ft. in -ifolustial/Coromercial 'Residential Water Supply(shared) ...,18:.GR0 ........:1 ..-....:.. .:..;%-.,...:.I.?:"''.,:g.".---. .f:';F.:,L'.:....,'. ..*:".. '-',.--./.....-2..",if".••• Irrigation . . . FROM TO • MATERIAL ElV113 CEbiENTI‘fETIECOD.&AMOUNT . • , Non-Water SupPly'Well: • 0 ft• 20 ft- bonionite• poured. • Monitoring. DRecovely ft. ft • _Injection Well- ft- • ft. . Aquifer Recharge • 0 Groundwater Remediation •::-19:aliD/G E RAVLTA;c7C(if 413li •cibre)••:•. r'i;:4...-. :_":.•••.-..-11.,'I.'•`.:•-,•-•-;.":.:.' Aquifer Storage and RecdrVery .0 Salinity Barrier FROM TO • MATERIAL . EMPLACEIEENT METHOD Aquifer Test ' ]Stormwater Drainage • ft. ft.. Experimental Technology 0 Subsidence Control ft ft. . •. . Geothermal(Closed Loop) • OTracer ' . . :20.:DRIG.1=ING.LOGiattiClfielditiihial slged,if iiReisir ..-..":1•l".;3. fi...'•:•*•;.f.y.,.....'I" e FROM TO DESCRIPTION(color,hardness,soil/sock t3'P e,grain size,etc.)Geothermal(Heating/Cooling Return) Othern (i.xplain under#21 Remarks) • 0 •ft. W ft- '61141 kW+ • 4.Date Well(s)Completed: 1131 I 3.-S Well ID# 26 ft ` ft. t)retolA red' • 5a."Well Location: 'AS ' q up ft ‘A.J. ty&kkt; --. ----. • _11\YANkgN___ _Liy_a,tki: . . ft ft- . C.,:'.:-:,•"k,„:',ki:-.:; ,,,,'':.,'7'-'4 ''' Facility/Owner Name • Facility ID#(if applicable) ft- ft. ' • MAR V k(40 el\F'Afilo k• L.03,AG MCoYtaiilk, AlC, 2iltr1 ft ft. . Physical Address,City,and Zip ft. ft ;flf,-_'•;71"::-;;.77-! :',,-•-•--,--- , . --rrie-Atill . • • . -..._ 4.1Z11....6/ .... (44.1 4g .f-YliatBArr.ARTLS't. ;:..;.,:"•-:-.T.-....:,;''.:....:,•!-_-4.,';:V_•_.:...?,--....:'''.1.-.!:::::::;-=-'1-, ..:Z1-..f..!1::::.):. . County PaMelIripntb9cation No.(PIN) . Sb.Latitude and longitdde in deg•ees/minntes/seconds or decimal degrees: (if well field,one let/long is sufficient) 2 • • ..S i 5114k(re, - 565t142 ration: N W .. )1 1/ 6.Is(are)the well(s)ilifPermanent or OTemporary Signa,r gr rtified Well Contractor •Date a IgningY is form,I hereby certifythat the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: 0Yes or..No with 154.1i.t.•C 02C.0.100 or 15,1NC4C 02C,0200 Well Consultation Standards and that a If this is a repair,fill out;mown well construction information and explain the nature of the copy of thii record has been provided to the well owner. - repair under W2.1 remarks section or on the back of this form. • 23.Site diagram or additional well details: 8.For Geoprobt/DPT or Dosed-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: • - 1 SUBMITTAL INSTRUCTIONS • 9.Total well depth below land surface: ri CD (ft-) 24a. For All Wells- Submit this foam within 30 day t of completion of well • For multipliwells list all depths.I).-dfferent(=ample-3@200'and 2@.100) construction to the following: 10.Static water level below top of casing: 5() (It) • Division of Water Resources,Information Processing Unit, • Ifwater level is above casing use"+" • 1617 Mail Service Center,Raleigh,NC 27699-1617 . -. 11.Borehole diameter: 6 (in.) • 24b.For Infection Well's: In addition to sending the form to the address in 24a ... . above, also submit one copy of this foim within 30 days of completion of well • 12.Well construction method: r OtCt Y.j . construction to the following:(le_auger,rotary,cable,directpush,etc.) • ' • " ' Division of Water Resources,Underground Injection Control Program, . • FOR'WATER SITPPIXWELLS_ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 11 3a 17,Yield(gpm) 1. • Method of test air pressure 24c.For Water Supply&Injection Wells: In addition to sending the form to • the address(es) 'above, also submit one copy of this form witli irr 30 days of 13b.Disinfection typeC)1\lOrtl/VC/ Amount: ZAC et completion of well construction to the county health department of the county where construbted„ Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources. • • Revised 2-22-2016 I I • " • " I I . .• —..