HomeMy WebLinkAboutGW1--00398_Well Construction - GW1_20240116 - -
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. 1.Well Cootreetor Information: •
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- David VIWATER ZONES' • -• '• -.. - - • •• -- • • •• .
Well ContmetorNarne
PROM. . . DESCRIE710' i
2906-A ' 1-' ; ,_‘ Willeinffirjergri4- .
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NC Well Cremator Cenificaden Number
- Aqua Drill; Inc. • . mom , TO _ . niAnrsisn • 770040$8 " B7ATERIAL •
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1• INNER •1 G OR TtriGmaztitrins==) ma ' ...., •• '
2.Well Constrnition Permit Ns 1411): 'E/LI/I...I.__ FROM in .
list till applicable well cansintetton permits(Le=Cow%M'at4 Variant:61We) IL. ft.
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3.Well Ilse(check well us* 11 ft. • ie.
Water Supply Well: •
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icioa MOM TO •INANE= nor aim un nu 1 ormEnsm. .
*Agricultural Eittammblic 0 at I ft fn.Geothermal arealieeCoolinE Supply) Ifl.' • ,rtleotial Whiet Supply(singles) ft.. fx In. 1.
At IndustrialICommercial 41:11esidential WaterSupply(shared)
11 kb,,on
- MOM TO . a . . it . . . .SAryla•
Non-Water Supply Welk
2 / 710.iii' rilY/5-Zio
lit onitosing .
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ft. it
rt ec,on Well:
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ft.
it Aquifer Rechauge DerromdwaterReordiation
39.SANDIGRAVEL PACK Ofnoorreehts1 : • • • •
11111•,offer Storage and Recoveiy • CriSalinib,&trier OP_E...1._-....arsi
dlii Aquifer Test °Stool:water Drahlage ' . ifL
ft
. Ilii Experimental Technology - °Subsidence:Control ft. - ft.
. *Geothennal(Closed Loop) Diluter ZO.DIULLING LOG Womb arlditirassIsItests Ifesseannry) -'• • - - -
.Geathennal Me:ling/Cooling Rentz!! *Other(.-.,lain undes1/21 Remake 1-414-WIL T° ‘ -' , "113:2"bardneureriaekimelald"Atei- .
re 4.Date Weil(s)Completed:Ofilk...Weil MO
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5 Well Location: _, .
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Faellity/OenterName
• EnithylD0(ifooplicolde) ft. ft.
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7A _LI - —.7G A $ I '. ' r- ‘.2.72' ft.
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' Address.Cily.and Ep' 6) ft. ' ft. •
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County
Pateel identification No.(PIN)- 0.—__________ :44..........N.____________-.
Six Latitude and fortitude in degrees/mlnetedseconds or dedmaldegrees:
Mug Eeld.'ene legion is enfiledens)
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O.Is(ore)the wdl(a) Pernament or 11:71Tereporary si arCertificd Well e- !. Data
By signing fhb An74 I Itraeby Clentry Btu lite=UN unr Owe)coostnnted ra accortrance
7.1s this a repair to al:casting well: C freis or END withiSA NCAC 02C.0100 or ISA MAC 0.2C.0200 Weil Cbristnailan Study&and that et
fats Is a repots:AU cm Ana=irdleonstnagion&rib:maim•W eget*:thenatuteethe comfthirrecordittebranProvidediothswenownen
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rapatriarder N.21 ytyparlasedlon or an art bad ofiltisjiMm
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23.Site dhtgium or additional wen deems: .
8.For Geoprobe/DIT oi Closed-Loop Geothermal Wells havbtlhe same YOU may We the hack°this page to'mime add'ikind well site details or well construction;only I OWI is needed. Indicate TOTAL 14UMB.ER ofwells construction details.You may also attach adalltionad pages ifnecessmy. •dnlled:.— ,_ ,,...... puBwarrm..mrnucnorqs I i ,
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Wrotahvell rielllil bellm'irmd surfseer-..—_oA,I_____-jft4 24a.Fur All Welbc Submit this Awn mama 30 days of completion of well
• For:maple well.!Bo at I diptharderreg(=ample-3 Or and 2@ftlary
cunskuction to the following
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10.SO:deviates leveltelow top easing: 11;47 (ft) Diation of Water Resoureis,Inform:aeon Prowaslog ME,.
Ifwatarlevel Ls dm cask&uscs'+" i
1611 Ditall Semite Center;Raleigh,NC 276994617
IL Borehole diameter: 0 (in.).. • •
241).Far Infection Wean In addon to Mading the form to the address in 24a
above,also submit one copy of this bon Within'30 days of completion of well
' IL Well construction methods iti;PI X101)149,, consituction to the knowing
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(io.met roc*,(labia diteetpask eta) •
Division of:Water Rennin%llo...5..yulla Injection%antral Program, .
FOR WATER SUPPLY WELLS ONLY: . • las Mail Service Center.Raleigh.NC 276994636
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I3a.y•ield(gpm) - -- Method of tuft (!):4 2( 24c.Yor Water/into&&Iniacthre Welk: In addkion to Sending the form to
the address(es)above,also submit one copy of this Sum within 30 day;of - •.
13b.Disinfection type: ,Amami: /‘e Z"' completion of well constsuetien to the county health department of the county
where constructed.
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Fenn OW-I North Carolina Department aft/honing/0i Quality-DiVisien ofWaterResoorees i Revised 2424016