GW1--02467_Well Construction - GW1_20240423

WELL CONSTRUCTION RECORD.(GW:11 . . Por IntemalUse Only:: '
. .. ' -1:Well Contraeborin•formation .. �
Gary Thompson : • i4.WATER ZONEB.
WrUCoatraoterNmne... .- To DHSCRIPTION
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aiO .� �ai3 �:� -.�r�clvc. • •6�•6PN1
. . . 1S:ODTER CASING(fdrmdti edwell OR LINER(iifa • • e) ' • - •
Aqua`rit Inc, • -
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. . 16.11INFIICASINGORTIMM°(geothermalclosed-loop). :
2.Well Construction Peemtt# k%4U P'‘o' Q3Q." ' • • :' •. , ' M_- _ -_• -Dry- MA�awt:
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3.Well Use(dinxkweli use):
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Water Supply Well:•.: ' . . - -, 17.8CREEN
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rttaM- pro •nrnaatertra .SLOT rmcraaFss t►ra'c'Bana
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. IDdustiiaWCommenaal ,• 'L. . .. DRcvdent al Water Supplycia' :
' .: . Itzigatiou_ . . : •.: .._..:. . '. .. . • .-
• (st"ted) otrr MATERIAL.
. Non-Water Supply Well:' . • ' •• .• it iL. �elint ie ►c®t�NI oil lr<
• . 9 Pour _+_1#d=��whlom�r: .
Mom D ►.. '.. ° $ a. . . 4.
ecHon well:. _ : . . .
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19
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Experimental Technology . -. OSubsWence Cantot ... • 2 '.• • 'ft. $. • • • - •
: Creothennap(ClesedLoop) = . : , Tiecer • • ILDRiLUNG LOG*wash additiontidumiif cry) .: •
. .: . tieothemsal(Reatinp(Cooling Retu n) f Odie ((esplain under#il.•ttemarks) D rkONJd,r ..tu7exte er ize. .f
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: 4:1ateWell(s)[7onipleted: 3-i%7 .+'4 welling• . §S• i _:60. : 66 rr( O '
'• . :sa.weal acatioo: . - : o.:f 2M S.,it '&4sgi,41e -
Fa ilvowaorNeme Facility .. f4 iZ
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ibt •Heinle Dr S orie iiiii.. NG: ►64.0) `� �: .
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2 f:ka�►9�► tiwi - _
'. - l?arcel ldentiHca to No.(PIN) - 1 REeL- : • " ti : .
ib.La86ade and iongWtde in deg•t who.tee/liewids or dodmal dew • '
(.kvian field,ono 04.gis..m.4.o • • ,1 . :
Certll3catlan' •
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. 6.Is(are)the we l(a)tlpermanert or LFTemporary.. • • •.s+l ?t of ...6. ea Welt , ' • Dare .
7.G thb a irepatr to an exisgit well ' Yes di No •: itiltl�I NCAC 02C OI l.SI Ar tCO2C 0 1m Tall erto»r c,ri mrd dreta '
. .ljihtvisa►BP S:(alloutlmotmAll1owuduetionbybrmtakei cpiatia,eCatanegpu !3bPYN'iMsi'enoodk91..k npYovtdadit,he;xeAo1rrio: '
• '' . . !ep*cruder#21rrmarlaaertanaronthebetOgfiideform •
23 Sitediagramoradditionalwelldetails:. •. : • , • .'
.8.For.Geoprolie!DPT or Closed-Loop Geoikermal Wells liavingdte same Yy may use the back of this page to pmvide additiunsl wen site details Orwell
construction,only 1(iW-1 is needed..htdieate_TOTALNUMBER of wells ar�de:Yon may also.attech additional pages ifnecessary : -.
'• drilled.-• .- .- . ... . . _ ' ' i.. ..
. -- - . - SUBMITTAL iNS1RUCT1ONS {'
.9-Totalwell depth below land sertagei- • •2.4.6 :
• ' •Forinuklpzletidtvlistalidepihirdf eat( 3Q200•find2 0 «� tea; or-AU Wells:l Submit this foam within 30 days of Completion of well
.l0.Stelae water letrd below top of eating: 50 (.) eonstnrcq ails following: P.
.mil
ficntar-levgl tr above ^ ' D1vision of Water s'
eaawA iIse 0 . ResonreM;Infoemafion Processing Unit,
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.• 11.Borehole diameter _•6. . •.• •(l,) . . Service Center, '
1617 MailPiC 27699161y
12.Well construction method: - . ..Re c r ' Rig^.' lays.-of
ays f!gimp. lotion. f w l
246.For Infection•Wells: In adds i to the •
.• -. abosre,•also submit one�pY-oPthis`farm w1�30 days
`.(i:e.ougee,t!atarr:cabl4 dlrecipacir;eta) . ' ' . . . • •. .. . . donsnit . . fo)(ow , i ehon to•the
FOR WATER SUPPLY WELLS ONLY: : : : ' of i". . � l Program,.
Divisiolr w®ter R�nnraa,Undegrrund IttOecHan Control
1636111ail ServiceCeater,Ralelgh,NC 27699-1636 .
o ' r l
1s Yid _ I liMetitbd of tesh•(3A4 i1:'1 T ' .2Ac.,Por Water Suaplir&i niect!oim welts: In addition to split's.
end ng the‘in to
ci . the add ss es a •13b D e: O bove,.also•submits one copy of.this form within 30'days of
:type:. i O -Amount:. -.'1 V O completion of well construction to the.county Health department of the county .
where contnucted:
• Paris tiW=1 !forth CfimlinS D opnonntoftwininmentatQualityi-Divisioaof'waterResourees , Rcvised2-222016
• I,