GW1--06985_Well Construction - GW1_20231027

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' * EL CONSTRUCTION'RECORD GW. . . .. . - - :•:
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".. It. . '' .iZ • .. tm31 l ;�I m . .-.. - •.":I Q (iieatibglCooling Supply): ,Fi'Reside»hal Water, single) .. . ft. .. -
Ind Commetoial' • .. . • Resideadal.Writer StP•P)Y(shared)
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• ' .• ' ' . .• FROM•- TO MATERIAL EMf4ACEMKTMBrHOD4AMOUNT. NO' star 6pPPfy wells ": '. n .. _. _ •
: . ' • IM_ Firing; . . O ft. •o E Aentafi:te.• Pons chips•4:I-I ASIiia.:
n Welts _.. ' - 13Recovery .:;ti:• ' . . a.: • . : • . - •
-.••: D •_: ferRecharge - . - Of onQdyvate°Remediation : -: • f • . ; • _ - _- • • .
111...... •^.storage and Recovery : S li -: - • .f9 BANIDHiRAVLLPACR(Irepule�ble) .. .
le _Test • ljaraRa TERt4L. Bl41PLAC�NrYLIgOD"
ahttity :
, ' , . . • [f 3toimvvaterDiaipage traDM .� it.
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' •• . .. �! . : .. : �Bub�dance.Coahgt '. . -.. . � :. •-te. . . . ft: _ .
P) • . ._ • . 31Yecer I. 20.DRILL-IIIVGL•OG&OathAdditIons tkee inin ep):
areatteidCoolingRetosn) f Other("eap lot.nmmder021 Remade): FROM - TO' • Dsat:nserrom(mt s;ruaam.soul a,,t4 41.1. e. ate) •d R: • '
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4.Da-Well(i)Ounpleted: ID-.14^�.3. •WeiDNO :••" s d tb -
si.W I Loptton:. . ` ft* �' tt: fil I
: : -tr. • :6tec -�i:11I)ec, l.- C, .c . • - . . $5-.IL •565. :Biur:&cwn:l•
Faclltty'�e•-,a Name . . .: : . . •: ' .- Faaility1D#.(ifcp,iiwhle) :.- -- :ft .•. • . • :fh: - - , .: :
20- of Ai .NC-r-,9 I�iaet gin . Fan ,:.ic;e99 17 • �' - a • `.r.,. ;f'-' - '' f c.
: • Ahi • r re. :.- : : ' • .21.REMAR1�4
• AncelldeadScidonNo.(P1IV) .. -. � -" C I i•�UZ ..
• • S6. l , ,i de tod loagttitde isi deEreedminute se oath Ordeelmal Alegre -. . . . . •'tn:°,,G.^4 p` '- ' :
(Owen. ,,one 41fio gie 4frugent) • . . - U a — .• - •. . • - .3ei'..,161: 36;5".: '.- .ii: •.V1.6-.'.191:0:c8:". : '... . .w .-..- e)cd :
• 2Z.Cerftieatione , •.ijL;;- --;-.,... -.: • .• - . . . - • ' . ..' ', . '• • -.
. .( )Wewel(q)e: • l t�
ermanent. or. Tam o sr of weucontnctor. . ' . . .
By itgr+►ng.d is f ten, hereby ce ti&that the vell(s)was(wend)eonvtruderi in iiiandquae'-
7.l(i tid Oro. to an exisdn
twin. : Yes .or 11To -. : .. . . i Rh ISANCAC 02C.0,00 or 15A Nate 02C.0200 Wel1Conabticden Stmrdzrds and ihara '
:Ifabb.•.dab'.Nlorrtbw►iviwell nitruclfonlifirctadonand-plalt!dipeabin.gfdu F9pY4rthis.1.n*1.psbeeripnovidat0df.eIvrlloivier•
• • ' • repitk -era1 e:inarleaecbiliwi py:Iback:kfthlafnit.
' - - 23.81te diagram or a•dditional well.detaWt' • ' •
'i.For a eoprobe/DPT or©osed--Loop Geotherutal We11i having fire same ' : You:>iaafr•use the back of this.page.to Provide additional.wel'site•details or well
eoastniedon,only!1 OW 1 itneaded. Indicate'TOTAI.NUMBER.'dwells eonstiuc#0!'detaIIs:.Yonmayalsoattaeh:additionalpagesFlu70464-
drIIIed: . �
J$URMITrAL INSTRUCTIONS 1
9 Total well depth below lurideurYace: •564 (fw) .24a. •. lbrnuWpte:wdislistelldepthat'd{deiene(exanw!e..3@2O.0'.and2®1009 . - l?or Au Wells: Submit this':fonn within 30 days of completion of well .
10.Statlewaterlevel below top ofcasing:' Lk)
constructi�tuthe:f6llovu t
10.SI r level to iFl i it b sae o+a " • �) : • Division of Water Resources,Information Processing Unit; :
11.Borehole diameter: .- . Qa) sending
1617 Moil Service tenter NC
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ion
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i ,.,Raleigh, Z7699-1617
' e above also ssubmit onee Cop Offddform,withi 30 om .
• • form to tiddress in.24a
12.Well coiuhacfloa tslethod: .4166 . �.t` days-of complettep of*ell.:
(i a "ratarY:cable,diroatpna6;etc) - -
t:onslroctIem to the tblhswhtg: - "
FOR WATER SUPPLY WELLS.IDNLY: - - u •. .
Division of Water Resources, ante,Raleigh;
Iq NC 7 Control Progeatn; • ..
1311.Yield(gpn) e�i ',Rile6, Z76991636
•1636 Mall Serrtrtee
method of test: re4iti.4 116p. Z4c.Aar Water tinnily'&lini a Wells?:.In addition to sending the fbim to
• ' • • • the addreso(es)above,also`Submit:one'copy.of this Akin-within.30 :of '. •
13b.Dlehtfedtlon types l T i-i V J /o Amount . /Cnt ,. ._• : -canipletion of arel eonatiuction to the:county health department of the "
where,constcuoted: '
'Form OW•t North'Carolina DilitiMunit ofBnvlsionmentat Qualify-O4dsion of Water Resources . e.m..,t 9 4,_oni..