GW1--07122_Well Construction - GW1_20231101

t� __ ___jT�'�'H®I� (�®�B __HIV fl) PrPnt Form
I.�/2U For rntemef Use Only _
CaltII atractor Information:
neron Bazin _ •
well Nemr li WATER ZOAlES 451 -l� 1 Rouit. ft. DESCRIPTION, -
1
NC W ll Contractor ntionNomber ft. R C-
Aqu Drill,Inc. N-I5 Oi17ERCASINGIformoth )Ayr urn cable �Y.
CompubyIdatne [nom TO r.�
© a. C4 0 ° afAT@2fAL Fit:
2•VI Construction Permit0:_ 0 2�p 16.II t CASING O1tT[iBIly �tbeimnl eiosea-long) ��
L3staUtrpp//eable wet leonchttetton FB011E 70 - ..-
3.Well Ferm+ts(Le.OTC.Cirimty Stale;Variance.ate) ft. inI ,T� MATERIAL
Use(checltt�use): ;y
ft. ft. Jo.
Water
Supply Well:
' Cultusel 17.scREEN
_ El cipaUPublic FROM TO .
DIAMETER swarm errE 'THICKNESS MATERIAL
l iti lad„ch;avC�m at ° �APIY) + ` al water Supply(single) is al
ill Geothtsffial
'itcsideatial Water snpp1y(shored) pi,
ft. ft. IQ' •
.*Im ;on
18.GRO1TT
Pion-Wnter.SDPPjYWe11: -FRom -To ' MATERIAL -. .Rs8PLACEnENTM,1 OD&AMOUNrr i
Monitoring P R' 2` G1. t
/pleat n Well: , dlRecovery p 7 R
it' •uifee Recharge
t Groundwater R�rediation ` 1
y'Viler Storage and 19.SADm/GRAVELPAcKOfapplieobre) . • _ _
*Aquifer Test
�$alisityBaaier 'FROM TO • MATERIAL arolrrACSR9F1VCn3EilroO
°Stannvater Drainage ft. IL
ItExpcamental Technology
II Geothermal(Closed Loop) Carricer� eoce Control pt it. $ i
20.DR1LLING LOG(attach'additional ejects iPaeQematp) I
W.Gen,ennui _cooling Ram) "other - ,)sinuader#2)Remarks FROM To DESCRIPTIONWen
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4.Date�VVe11(ffi)Cbmp> IO/nYb 3.Well)d , ft
So.well Location: 3 l30 `)�Sf �c�►r' 1-[.,.
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a0 rt Co)( it. M. .
FacPfty/OWEIZNed �a;
m 'I,
rBeyn (>Fnuwyte) ft. ft.
270 • ''\
Physical Address,Ply,and Zip • et. ft. •,.'
S(nr��� 21.REMARKS NO V - l
Coup Pam elldentifestionNo.(PIN) ;P�,U " -.' �, P'
5b.]La tacit:and longitude in degceeshn untee/seconds or decimal degrees:
(WwCll aoio)atllongissumcimt) (� �i lx
N go, �, 1 22.Certiftcadon: t"
' w
• o (b2 ;
6.ds(a the well(s) Permanent or OTebipnrary stgmtarooeCaoeed:wellConkaetor ante ,;
B3's(6ming this fom6l hereby 'that the weirs)sinsAmer)eonslrnaed In ce-rdmtea
7.1s n repair m an existing well: Yes or No with 1SA NCACO2C:OI00,or15ANCAC 020.0200 rd1 C astruetton'S,retndordi and that a -
r/ftrWrlsore�atr,Jlllar+i�romrxzllwnstrr ann(omiatfon' d zptarnpienotureojrhe COPYofthr*n b pmv[dedtothexaNI— n;
rppalrua ert72Iremadasertioaoroathebadcojtlitsjorm.
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23.Slte dlagtnmoraddillonalwelldefltila;
5.For 0 be/DP'd'or Closed-Loop Geoeheraonnl Wells having the same You may use'tbe back of this•Page to Wmvide addilioaal wc(l:site details or well.
eta. . on,only1GW-1isneeded.T°diwteTOTALNUMBERofwells construction details.You may also attach additional pages:ifaecessary_
drilled: SQBN1117[A1STRUCTTOIVS .i
9 Total veil depth below lend smrPace: f3 2 5 ( ) Ycii Allwells: Submit Otis than'within 30
Aorwadi cues Ratai&Ohrijd{�eren'gm'Ple`3(O�It10•anda®/009 days of completion of well -cnnslntcdoato We foAowing:
le.Ste water level below top ofcns1l1V ( ) Division of a Water Resources,Information Pro
"water l el Csabovea�tn&u i" 1617 Mail Service Center;Raleigh,NC 2769916 '
11.Borehole diameter. (In) 246. o nlectit►p Wells: in addAIon to.sending the:form.to tbs
above,also•submit one,copy of this form within 30 da of angoras in 24a
l2.Weg construction mstbod: Co oonstitictinn to the follouriag: ►pletioa;of weir 1
(i e.anger:rotary.cable,cheap"etc.)
-Dlyislun of WaterPesomun Und-' md
FOR W TER SUPPLY W LS'ONLY: 1b36 h!,Il Seevice Center Role1 eon Control ,. • • ,
g6,NC27�9-1635:
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13e.Yid (gpat), l ,Method •°Hest: •. Wsttsr 8anale dc.Io�eeHoa W�eltsE In addition to s ;
_ i.comp24.e..Fiewii.r.
the_eddtass(es) above,also adorn;one:e age ;. _ _ apy`of._thls.form.Amtetmt: �D 'of well t on to the -dust <��
13b.D1 f tloa type: 4n where constrain& � e4L die eor
oDiana DepoAmwtof Eavironmenml
_ormGW-1 moth Q1iv1 -b�ltlaaoFRhletResoueos ltoviaed.2.ZZ2016
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