GW1-2023-02626_Well Construction - GW1_20230410

NVE LL CONSTRUCTION RECORD(OW-1) For Internal Use 0
1.Well Contractor Information:
(fe 14.WATER.ZONES
Well ContsusclorNanse 031 TO DESCRIPTIO.N
14,
'M8 Z0'
-R
IL
-1-In W 4r,AlIq Re t.2e
NC Well Contractor Certification Number APR 1 0 2023
15.OUTER MSM bl
-CASING for multi-cased sells) RLJ1%ER(ijCap 1i'I so
I I M_�KXESS ffATE
ft.
Company Maur:
16.MNER CASING OR-TUBING closed-logp) MAT To -5 ==7
2.Well Construction Permit 51E R If KNESS MATMIAL
List all applicable well consiruclion pennits ff.e-UIC.Colw(r.5rate,Mariance,etc.) ft. In.
3.Well Use(check ivell use):
Water Supply Weil: 17.SCREEN
-OAaricultural 02%,lunicipal/Public FRONT MANW.TER TMCKNF-c;S- 31ATEMA1.
DGeolliernial(HeqtingiCoojin-Supply) o 1(0 "r- Ct Jr2- in 6, Sck 'jo P L)r-
Midential Water Supply(single) ----
ft. fL is
01ndustrial/Commercial OResidential Watcr Supply(shared)
M.GROUT
Dirrigation -0XVcils OO.GOO GPD FRO-11 i To 1MTEMA
Non-Water Supply Well: Ct Z. 'L (3 r 4tU L4
QWonitoring ORecoven;
Injection Well: -- V f'-
0Aquifer-Re-chirge ❑OsGroundwater Remediation
19.SANDIGRAVEL P.ACf-(if livable)DAquifer Storage and Recovery DSalinily Barrier 1 2.
1`11051 TO MATERIAL
Aquifcr Test OStormv.-ater Drainage t( fL FTHGD
C,
I I 'q 2- ff- 6-P 4 / A
ElExperimental Technology
OSubsidence Control ft.
(Closed Loop) OTracer 1 20.D lLljpLqLOG(ato-x:liadditinaislieetsifnecL-
ssaarv)
'dGeothermal(HeatingliCesoling Return) To
I FRO:%,
00ther(explain under=1 T RcTra:i�s i ; ft ft. In sh'-etc.)
101'a ' ;?()f a I&-�
. 4.Date lVell(s)Completed.• 3--'1 -f;elI m#j,4 P& jol o a
3-e-4 ft. S2,,V ft.
-t�el C�r
0
-,a-Well Location: SO,ID f" 6., 'L
Jr
1,9 2.
Facifily,"MvnerNatne ft.Facility JD#(ifapplicable) 1021,_5' 1631* 11 rE
er Leep /0 3,7yft n. sr-
ca Physi I Address.Chy-and Zip (H. -S-I+
ft. rt.
MOO QL "1-7'70 6 -3 It 6 Cl�. 2'-RE""'ARX5
FSMITIONI-1-1-�--
b Cr�
Am c-t4q,
County Pz:-zal Wentifiration 10-(PDO
5b.Latitude and longitude in degreeslmmutesfsecon dl§or decimfdeggrees:
(irwell field,on.-lat/insig is sufficient) I
22.Certification:
tv 7-
3 2
6.Is(are)the well(s): Opermanent or OTemporary Signiatsurc ofCcni , Xwell tractor Ease
By signing Uric foes,I herchrr rerti&that the 11elt(s)Irds(slerL)cmrstructerl in oc""j"'ce
mirlr
7.Is this a repair to an existing well: L-]Yes or eftNO JJA AVAC 02C.0l[jq.,,,15A,,rC..jC fj2C.0200 Hell Goartruclion Srandodsand that.a copy
#'flds is a repainfill not knot well corwrarr.".n injitmiation air,(trplaj-'rs,,'-,'-enantre oftile qr1h1v record has het?zrrrA-,-ded to the is-ell ou-ner.
repair wider II rctuanfx section or or:re hizn�o"tilis ron".
23.Site diagram or additional well details:
S.For GeoprobeffiPT or Clos-ed-Loop Geothermal Wells the same You ma`'use the back of this nal-le to provide additional well construction info
construction,only I GIV-1 is needed. Indicate TOTALNTLTMBcp orivells (add ISLe Over'in Remarls Box).You may also attach additional pages if necessary.
drilled: 0 a-N n ar%
9.Total well depth below land sur-f2ce. 24.SUBN=A1. STRUCTIONS
Far undaple irelf.T list oil ee -0 z.. Ir.)
xaniple-3@ O'crtj c.qj Submit this GIV-1 within 30 days of well completion per the following.
10.Static water level below top of casing S6 tit m 24a. For AH112115: Original form to Division of Water Resources (MIR.).
i(ii-ateric.i-.Ih;aboi-e-casing,use- information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 7 (in.) 24b.For Injection Wells:Copy to DWRt Underground injection Control(IUC)
Program.1636 MSC.Raleigh.\C 27699-1636
12.Well construction method: 561) (C'
I i.e.auger,rotary.cable,direct push,etc.) 24c.For Water S and Open-Loon, Geothermal Return i"
county cuviromnmi�-L-1 1111 d payment Or The county where installed
C"15*Copy to the
-
FOR WATER SUPPLY HELLS ONLY:
24d,For IVater IVellS producing,over 100'000 GPD:Cop),to D\%,,R.CCPCUA
13n.Yield(gpm) 1611.2%�ISC7T-icl-7i,-,�--qc27699-1611-
Method oftest-
13b.Disinfection type:
Amount-