GW1--01879_Well Construction - GW1_20240322

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WELL CONSTIZUC CTUti RECORD (;W-1 For c n a ilsc n1rJ —I DI `
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1,Well Cnr.l racier inforrnation: /,` {
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Well C:onisetct.r Name / ��SS IL 1� 1 � ���—
<. ; J L/ — ft. (! fl ft.
NC Well CoOte cteCttbfi-
0.4Nclr£+r: iS:o13T31R ASINO((ottitultl raatd.wttbt OR LIN ', fa •fea6TCRtA I.
l t1811111111
s9 DM __ T111CIQC M TCRIAh
/+� n. L n. / to 1� Gam.
t oa ,any Nsnx 0 ((Z7Q 1 11 O :.
-mu ti(:A tar'OATUDINC,Tibdlherttal t Beed•::uil11>�3'' �.
A�'* -� ^ mom FM UTAN[Tr.R _ T111Ch'�f�5 MA'fERUI.
2.15 ell Construction Permit N:pe I7c' , !n.
rOf brit cm'',,,Ic we8e!.nafr,neon Mimeo, e if!..C.-'4.- $,Ice.lc:etueee Ct, ft. h.
ft It. to {
3,Well Use(cheek well use): — -- g ,,
17.SCR t UN �u '+ ATt
Iater Supply Well: rxt'o o III+,[!n it `i ul♦I/I THICKNCSS_ MATIRtnl.
A cuinanl tunic i alit u`h: ,
g t �;, C (? r,. ft. m
Geothetmnl Meriting/Cool n Supply I eft s,dent ud water Supply(single) n, n.
IndustrinitCoanmefelal [�Resuleni to]ll'atet Supply(shared) "''tg.(:RULrI'-''ts. ,i' y,r s b'., -_�—
Ifflr.,ahan rIttt TO .NATIRIAI_ r.NPL.\t C,fl ti-r,Nr IllUU i AMOIaT
Non-Water Supply Well: �� f 1'� �/ t��l U; ]!' (elLL�<<t1 �a— I
Monitoring: QRecevery h. ft. /`� [_��S
ection Well: fr. n. G1
quifer Recharge QGrou tdwslcr Remedtanoo I�.SANDlCRAv"):1;PACK(if al It altle)x :a 'r �4 F_, $;Y :a.
qulferSterageandRacovcr}' EiSitlinityl3anter raovt TO 1 MA'IIRUL 1 rN I.ACIM �rsfenton—�
qutfeeTest OStnrmwater Drainage R ft.
xperimantr+l'Technotogy 0Si:hsidenceControl h. If•
oihamal(ClosedLoop) QTraccr 20.DRILLING Lt)G{attith aktdltletinr3heefkifeliceirary) t
eothermal(FfeatitlpjCCxtling.Return) QCxFtcr(explain under N21 Remarks) fxust 1 TO DESCRIPTION(eeter,heethmt uilireek ripe a,+ ..,etc.)
0 ft. w , f'' t')t// �?vJ'<>Cri)C+ AC.' ' J
0.Dace Well(s)Completeddddd�`�'(�'f 1v411]llu / it--ft. L� IL (eery p ^4
Ss.Well Location: P.
� -fL n. 1 �h. ,/ -
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fit/dam '7'05 ,L�
Facility-Owner t.'arne Fa<tl,:y lf:n Of a lwabk) ft. ft.
_�-`6 W%�G�Ac<<.: %.1'), __- ft rt. - r
Physical address,City and 7.i' ft. ft. i
ialrC'eunty Parcel Idc:11;:i:411.1 No (PIN(
Sb.Latitude reed longitude in drgreerrsinutes'seconds or decimal degrees: ---
(if well ti::d,aac lat9dog is suffleient i 22.Certification:
l // /,S / Ji
_ `mo 7
t//z3Llr(,3O N$/ " /', 5'f7p 11 /
6.is(are)the s,eII(s) rrnanene orQ'femporar.v sr f eriified WellC nd truiv Outs
3v algnt.ag Ale Prim,1 herehy coney dint the 5Y11(i)was(were)eonttnrrtr,rn accon6tn,r
7.Istbisarepairtoanexistingwell: Dyes or ION() w,rh1JAh'C.1CU1C.016JcrISA,Yt tC01C.0200WetlConsuuce/onSianlardfandthara
:the natl.1f this is o repair,f tt our known well calf f•fly:r,'n tryrtutealtvn ass(ert-,',a:n re:),:a the
copy cJihu record has been provided to the well owner,
repair,ender e11 ee mania section or e..1 the bark Orr AUJ<+rnr
23.Site diagram or additional well details:
S.For Ceoprohe.tDPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or welt
construction,only I 6W-I is needed. Indicate TOTAL NUA1131:R of wells construction details. You may also attach additional pages if necessary.
drilled: (c-� Sli6ti11)`I`AL INSTRUCTION
9.'l'otal well depth below land surface: -� ] fL) 24a, W .
• For multiple wetta itrtoildepths lda9e,nt(ent. .ii 3 and2@1001 For All Weill: Submit thisform within 30 days of completion of well
construction to the following.
10.Static,rater level below top of casing: 31,I (1.) Division of Water Resources,information Processing tlnit,
if water trv<1 is oLo;e eating, ur"+ 1617 Mail Service Center,Raleigh,NC 27699-1617
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11.Borehole diameter. (in.) 24b.For Inieclipn Weill: In addition to sending the form to the eddies in 24a
12.Well construction method: Q �j above,also submit one copy of tt.is form within 30 days of completion of well
(i.e.auger,rainy,table,direct push,r:e.) J construction to the following:
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FOR WATER SUPPLY WELLS( NLY; / Division of Water Resources,Underground injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) a 7 ,. .Ntethod of test:A) �-� 24c.for Water S�lvnh' (nisei QI)\Yells: In additiutt to sc�iding tI)c form to
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// Qtc addrecs(cs) above, also submit one copy of this foml within 30 days of
13b.Disinfection h'pr: L Amount:, C�s ccmpleuon of well construction to the county health department of the county
s.
k whereconstructed.
rForm OW-1 North Caroline Dccurtntect of Environmental Quality-Division of WAtet Resources
Revised 2.22.2016:•
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