GW1--01819_Well Construction - GW1_20240322

WELL CONSTRUCTION �'
RECO (GW-1) For Internal Use'Only; !:
1.Well Co ctor.)nfo lion: -
• -
•
'14 WATfR ZONYS .
Well CanhaotorNamo .FROMTO DESCRIPTION
/d0 it'
3G6 f. <
5. 3s •
NC ContnUwCartiScationN •
ft D
�;) 15.OUTSR CASING(for multi-cased welh OR LINES.Gfap liable)
( )✓1" FROM ?O . DIAMETER • TSICrWtSg
CcmpsnyName R I ft I i; IrL MATERIAL. -.
/l , , ( 1
2.Well Construction Permit'#: v�7 V�! 16.INNE R b1GORTf1BDMG(Reotlrermdelafed loop) •
nom TO DIAMETER THICKNESS MATILRIAL
Ltd app/imble wen eonrinwtion Damns e,WC Cawty,Slate,Valance,aim) • 1. •fr. 3o ft 5 7 (a •
3.Well Use(check well use): • • �I. i C A- Y+T
ft.• ft is
Water Supply Well: ,17.SCRENN .
•OA cultural: , PROM To •
gn MunicipayPublic. DrAI,>trin seorslzle •THICKNESS MATSRru;
OGegthemrel(Hcating/CoolingSarpply) •idotrtiel Waters l (single) f t _ -
' • OlndushriaUCommercial Supply
( .
OLrigatiott O identiel'Water Supply
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( Bl) 18.GROUT ' .` f, '.; -
O Wdls>100,000 GPD '• -PROM To : • MATERIAL • Tar<uCURNT=rsoD&AMOUNr
Non-Water Supply Well! • ' ' • .. . • ft aft •
OMonitoring' , ... D�Y�. U n�. /1/� .� a
Injection Well: • R it f"� r _
' ' OAquiferRecbargo ' ' OGroundwaterRemediation rt. ft �: ; ` 1 •
OAquifei Storage and Recovery , OSelitlity Barrier 19.SAND/GRAV/ILPACK(if applicable) ' •', r. • ,
DAqulfer Test, PROM' •TO MAT=RIl�: P16tPrACP�HEN1'METHOD ''
' `17Storm/stet Drainage , ft R
OExperimeuial Technology _ I' .
OSubsidence Control
R R • ' •
' ' RGeothemftal(Closed Loop) •li• ' OTracer `• ��`'{,,' •' ` .
20.DRILLING LOG(attach additional iheels if access'
cce arary) • :'t'
OGeothermal(Beating/Cooling Return)• OOther(explain under#21 Remerke) PROM TO , �aWoek hv4 snia�.tal'
• DESCRIPT19NCahnhardn
ft '' it
u 11,
'`-"- 4.Date Well(s)Completed:•e.3—7:2 y '.Well ID# i<'
Sa.Well Location: , . ft ' • •• r{ • '
Facility/O rrName g i +.k"'^'' '
Facility lDM(if applieablo) ft • ft • k r,:
Physical Addtnrr.City,and Zip . - • (J �� ft IVI n 6
�s A (�1� 21.RL61ARILS/r t114%•i v;�:Part��3.;,••,�:., ,r.::.. •
- v,.i.
PirealIdentifiatioallo.(Pltt) ' ; DIMCC.P.,1 y ,•c
Sb.Latitude and longitude in degrees/ntinntes/seconda'or decimal degrees: • •
'!
(if wall Salt%ode latilona is iutSeieal)
` 1_ AY
- j ' , /� .► 22.CerfiTie lion: 4çj4
• • ;. i
6.Is(are)the well(s). , ermaueat or OTemporary •01 59PO 1 8igomwe ofce'tgg Well Contractor 1 a I 2
� � Data
7.Is this a repair to an existing well: Oyes or, l9i�o. By signingthhltfonn,Ihsrebyeat►&i/ml i/;sw'aU r war ) ceordancswim
ISA () !nett eon Sienddlna •
...phis Ira reel s roe dh .bee pn,vii 1VG the welt!lon Well Cwwtnrcdoti Slmrdardr end dial a copy
pair fill out teeti nor one theaack thisfor oa mid explain the names of the elks record her Uoenpravlded to iraU'owaer. • .
'npp/rrender/7l remarlrsectloa or on Unabackoflh/rrmm: •. - ,
• . 23.Site diagram or additional well details:8.For Geoprobe/DPT or Closes-Loop Geothermal Wells having the sumo ' • You may use the back of this pogo to provide;additionnl well'coastniction info •' '
dconstruction,only 1 GW:1 is neede4Indicato TOTAL NUMBER of wells (add'See Ovet'in REoiarlo Boxy You may,also attach additional pages if necessaiy' ''
rilled: • : •
• 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 3'�,1) . 1' •Formutliplewellrlistalldapthibedlglrent seam •(f`) Snii®ItthisGW-Iwithin30daysofWell•com letion
( pe3(a)700'ardi(�to0) P per the followlng
•
10.Static water level below top of•casing:' . �Q� 2di'•For All Wells:'Original f°mtt,Division of Water Resources (I)yIIR),
Piocessam Ow 1617 MSC',Raleigh,NC 27699-1617
11.Borehole diameter: ' . , ._
{m.),, 24b.'For Iuisctian'Wells:Copy to I)WR,Underground 1p'ectioa Control
(IO— .n . Program;1636 MSC,Raleigh,NC 27699=1636 C)
12.Well construction method: !\ b'f a1 ) / yI/ f f, . •
• (La auger;rotary,cable,directp'urb.etc.) 24a,For WaferSuDply and O'peo Loop Geotllerraallretarn We11s:'Copy to the
county cnvironmentnl health department of the county where installed
FOR WATER SUPPLY WEI T S ONLY: ; ' 11
• 241 For Water Wells iirothidag over(200 000.GP):Copy to D
13a.Yield(gpm) • 5 ' • ^ - PennitFro' PY WR,CCPCUA
Method of test: gram,1611 MSC;Itale.O.NC27699-1611
L • 1r
136.Disinfection type: 1 •1 /I T Amount: ! '�,'I .;
•From GW 1• North roman!ofErvird Nth Carotin;�: ameaW Quality-Diviriou of Water Resourcos. .I. :� -