GW1--02394_Well Construction - GW1_20240423

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ld INNF:It t:,tslr ;OR TUBING arrant dimities .tAr• r. _�
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\\;.i l..r is het well n•cl: - —_
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t', \Yell: . - 17.SCREEN .
�I.1'I'IV FRMtI TO DIA llEfrR 4LOr TiOM 17IICKNE31 Lira N_
•1.• .',;,❑a, ❑`htnici ilil'uhlic It. ft. is,, --_- .-
,, ., .. Icaung'loolulgSupply) ' iesalenttat\V.tterSupply(single) R. ft. 6L --
•. . Iri rvncnetcial 0Residential Water Supply(shared) a.GROUT
•`, n ❑Wells)100,000GP13 1.11CM -TO MATERIAL I.sfFLAfrl:F14T31FTlNlh i,t)f41:,2:, ,
Non.\l alter Snppl Well: -- 0 n. a0 Ps. ' rioIeQl _- __ _ ,
'Vo :A:nig DRccovery h. ft.
Injection\\cl); •
ft. ft.
1,_u.!er Reehargc OGroundwatet Rcmcdtation 19.SANDIC R.IVF,L PACK(If applicable) --- ---
._-14m::r Stage and Rccorcty OSalinity Bonier FROM TO MATD1UL carrr.CRMra'T str.runc _. •
J.itit::fcrTest ❑Stormwater Drainage ft. ft. -
:'LsrenmcntulTeehnology ❑SuhsidenceControl ft. IL
JGeothernai(Cased Loop) DTracer 10.t1RILLIrvG LOG(attach ndditional stems if neervarrl
FROM 'rn TCSCR II'r1ON tc lo..Lnr)nn,.toilirarM Irpr.„•tam lire.or.. _
GGca:l cent(l icatmgCoohng Remin)q DOther(explain under 021 Remarks) O ft a ft. �.._, ^ SA %l
4.Date V.cll(s)Completed: I-LL-ZL( \NellIDtt g ft. aL/ ft. /1AA.
(f•Y+ /_`x, ��
_l ft. '1_ n. 1.�/ Fx
So.N ell Location:k;ill
G7t QIQS -t f"n r :
II rr r,. rt.
Fac•.htylCourt Nam.: pantry roll(trapplic,l,c) it. rt.
901 ±OrnSQSe . )2Zi IdJett6e.il file a75 / ft. N. APR 2 7 707-4
i'l:)s,.el r,J,1,<es.C,rv,a,.a Zip is. h.
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1, I!`n 1LL 21.nRMAIIKS .•�:�
Caumy VI roreel!donut/cation No.(PIN) Used hardened steel drive shoe.
•
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: - -
4rtrctt Rdd•arc lat/long is sutLaent) 22.Certiric;ni
3 • l 375-/ N — --13'. 1+05g:7 �— 6/I-�-Z
6.Is(nre)the well(s): N'crmuoenl or O•fempornry Striatum of Candied Well Contractor Date
llv stgrwrg,Isisinrut,I herby ecn/y dun the n e/lO ens fwer,)enuun,e:ea al neemilnnc-.:
7.Is this a repair to an existing well: ❑Yes or )No 1Sa NC4C 02C.11100 ar ISA NCIC I00O2011 It12//Cmutrnrnnn Standards mid dot:„... ,
:/:iris is a ecp air,fi/I au,ku rn ,mtu u, ,hell ln,ean n a fanstnttnrr au exploits the unsure of she f rhlr reran!hn.Isecn pro.'sled rn,he well wvner
,rpn,r,aster r,21 reuaris urnsns Or WI dm back nf,lu form.
23.Site diagram or additional well dclnits:
S.Fur Gcuprobe/Ul'T or Closed-Loop Geothermal Wells having Use same You may use the back of this page to provide additional well construction a• -
cttns:ruction,only 1 GW-I is needed. indtcate TOTAL NUMBER of wells (add'Scc Over'in Remarks Box).YOU may also attach additional pages if recess„•
drilled:' 24.SUBMITTAL INSTRUCTIONS
%.'Iota!well depth below land surface. C Tas 5 (ft.) Submit this GW-I within 30 daysP of welt completion per the fallowing:
hoe nudhplr wells Its,all depths ttIsh iennr(example-JQd00•rue!IQ/001
24n. For All Wells: Original rota to Division of Water Rcws.rees Cli • -
10.Static water level below top of easing (EL) Information Processing Unit.1617 MSC,Raleigh,NC 27699-1 6 1 7
,f.racrlow/is stburc cuuug,,lie•'t
24h.For Injection Wells:Copy to OWN,Underground Imcerien Ca:::el
I lLarelrule diameter. 6 (iu.J Program,1636 MSC,Raleigh,NC 27699-1636
Rotary
12.Well construction method:
24c.For Water Supply and Open-Lamp Geothermal Returns W ells:Ce'• '
; _t,get.lusty.cabin,dimes push,etc.) county environmental health department of the county wit se #:rade3
felt WA'fElt SUPPLY WELLS ONLY: 24d.Fur Water Wells prod ueine over lilt/Alin)GPD:Copy to Ott' ,n
�(' BLOW pentad Program,lot I MSC.Raleigh,NC 27699-Int I
I Sal.Y0.1d(gym) I V Method of tent:
131,.hit mi014 type: HTH Amount: 1 lb.
,un r,"I.; Numl,Cantina Dvp,usment of Euvi,mua:ntal Quality•Division of W nice lteamuces -_