GW1--01106_Well Construction - GW1_20240216

• WELL CONSTRUCTION RECORD(GW-1) For Use Only:
L./WJe11 Contractor iafornmfoo / j .
3 _x „• 4 ��/ U . egrwfl-,_, 14.WATER ZONES
weticasnaaorrTame > too I DIMCIUNSION
.13-72 4 M7yr.G 73 IL 90 IL id I-t Ai if/Zs� Lkd:
NC Well C Cati6�ai�mbs I -
/� ` IS.ODIER CASING(Gar rind rMDR(if
( /�__/L. GU�'_ s /�-d�z _L PROM R 1�• $ �in.
TRIMNESS MAMMAL
Company Name T
/ �J 16 INNER CASING ORTUBlNG(te°i ldaaed prop)
2.Well construction Petrmitd: 4L?/2 / FROM TO RIAAREER THIERNESS IDITERIAL
Lis' all applicobletiell oma►attlmrpore&(Le.UIC.Coma Sam Veda=etc..) -f-i I. g/ ya in. &4-41 d /)VC
&Well Use(check well use): /Co IL 9 e fL V I" iO' Se-A ild PVC
Water Supply Weft ' T
I'Fl;OM in DIAMETER ffiarS= TRIMNESS MATAL
cipanthfic
•
t]Gt:otltetmal(Heating/Cooling Supply) Gdea Water �! IL 5'(0 a y rr 64 3ov_ s.S
Supply tl_ s to. _
OIndustria1Commercial denlial Water Supply( iti cRour
) I .
°Irrigation " OWens>100,000 GPD FROM TO mammI==men&amoura_
Non-Water Supply Wdl: vff. J/ ff. r4PAL1.3_ v .
P _ ------- -
lgjattoa Welk
-
tt. R.
txitOmm r 19i.SAND/GRAVEL PACKfdappIkNc)
QAgaufer Storage nod Recovery °SalinityBanier FROM TO 0 MAS�R��,,�� p iallecmmrr on
DAgnifcrTest O5tvunaratnrDtaioar�s 2/ A f k tt `ETC z4 - f �)dm it
er�l Technology OSubsidence Control_ It- tt
°G l(ClosedLoop) t7R'iaar 20.DRILUNGLOG(stmataidtliend sheets famemry) •
°Geothermal(Heati�CoolingRe� m) °Other(explainderd21Rematle) liwm zo D IQ(nrt;isattaeb,anAatt pafoai�ety
4.D(e 1 2- 5"z%wormy $ IL za IL e4 m' r..r --lff.4
Sa.Well Locatiom Z0 It. S$" IL 'Rea. li-ltkin4. .
hoil Ar to vt (,'ill e-A 1 I - S.as-n. 7 3 IL Z•— e4*OL re arc-o✓/ .k�/ 4-
r Facility OwaorNamem#(if s ieable) 7.3 xi. 9�o a- �i� Ts gaze i S44
AS-41Vt../ha ss Gal ,Sc t0414 -4 nrc3 Are. qb IL %/o-ft- -nisi- s.dito 4) M .
rla9�alAddtc .(5n.andzlp ft. ft. ' r^ , s!
!lalw7>! 2LR a ..o L.... ®/fir",. '
Pascel Idoortoafoo Ka •- r Li; I io 2024
Sb.Latitude and longitude in degeedminutdsecoads or dedmal degrees
Owen Rd&one hams isauffideit) 2LCertificatiion: tllt`�,�rirraien 3rr^ 'l2 UM
3S6 $' f-1.�." N ?°1° z./' / `� - w 1(4. J�tf r� te a_'i,7_,
6.Is(are)dlewdl(s) ermanent or Qtemporary ofCefifial Well Caffiractar / Date
-- -- - Bys thgarffomAlhe eayavliyuuuuheire1I wa s(were)axszbuctedinaaao dm cnvith---
7.1s this a repair to an east r' gwdt Oyes or I14.1VCAr02C.0I00 orIUMW 02C.0W00 Weil Cardmdten Standards and that el copy
11tldsisargxrinJillanbemmve!!consbaelienb ioneraarpiainthe:Wareofthe °furls=mak=heenPro drdtethewellmnm:
repair under 021 swamis section or am the back of thisform.
23.Site diagram or additional well details:
$.ForGeoprobelDPf or Closed-Loop Geothermal Wells having the same You may asethe back of Ibis page to provide additional we l ooashaction info
o isuu ion,anlylGW-lisaeedDd TOTALNUMBERofwels (add'See Over'inRanarsBox)Toomey also attach ad 1pagesifneaessary.
drilled: `� jj' U.SUBMITTAL nanwerioNs
9-Total well ds beI wMo� �v (EL) Submit lids GW-1 wiHda 30 drys of well completion per the followinw
For mulipie wells list all thirds if a ant(esample-3@200'end 2@i00)
10.Static water level below top of ensinr b 9c �) 'Aa.For All Wells Original funs to Division of Water Resources (DWR),
Ifi laver hi above Information Processing 1617 MSC,Rainier,NC
use+"
1LBmrholedfameter_ (hi.) 2i46.For Infection Wells Copy to DWR,Underground Injection Control(RUC)
Program,1636MSC,Raleigb,NC27699-1636
12.Well won method: /711/0 ?a 24c.ForWater ,1, .lyand Open-Loop} Geothermal Belm nWells:Copytothe
(Le.auger.mum S&teaFos%etc) /
county health department ofthecaamywheaeinstailed
FOR WATER SUPPLY WELLS ONLY
?Ad.For Water Wells over
over 100500 GPD:Copy to MR,CCPCUA
13a.Yield(gpm) 1 Method of test pi. 1611 �Raletgb,NC 27b99-1611
13b.Disini'eenon type: t to s 7' Amount: 72I b -
Farm GW-1 Ninth CatoliaaDepattment afRavaoummtal Quality-Division of WatcrBesMaces
Be:visrd 66-2018