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HomeMy WebLinkAboutGW1--05666_Well Construction - GW1_20240920 . . 1 e.nw.w, WE,CONSTRUCTION RECORD(GW 1) For Internal Use Only: , L Well Contractor lnformation: —5-e—iLC -2\I I ;Sk-Ql* AQ./rf•O n 14.WATIIR.ZON&S WJlControcterNime FROM TO DESCRIPTION a04 tL: Q�Q•IL q CspM NC Well Contractor Certification Number 15 OUTER CASING(fornol8•eesedwells)OR LINER Of ) Stephenson's Well Drilling, Inc. FROM TO DI*MET= , MUCHNESS MAT Company Manse ft. 5 IL , 6i"a• spN al ?NI i 1cnip cats laGon G(mothermdelosed-Isso) 2.Well Construction Permit: �� 1ritOM TO DIAMETER THICIQ� _ tHAT&RtAL Litt ail applicable nail aannhucdanp orn&(Le:WC,Cow4i.State.Varimux etc). /,A fT• It 1, ! la 3.Well Use(cheek well use): n I. in.r. Water Supply Well: bgo� DIAMETER SLOYS== THICiO DIS MATERIAL Aadcultival At/Alt IL l! In. Geothermal(HcatinglCoolinl Supply) 74!Residential Water Supply(sin o) n it,, Ira. IndusteiallCommcrciel it• '- WaterSuppiy(sbared) la atom i, Irrigation . PROM TO MATERIAL {fet +C (TM!1UODDASIOONT Non-Water Supply Welk Q ft. aQ le,1421�it [ 04( IQ co(b iutp' m»toring - -- ['Recovery-- --- --- .- - ti: St. C h}e t - injection Well: rr� ft. - uifa I� Recharge CuoundwaterRemediatiw 19 SAND/GRAVELPACKKO mIP1Icable)• _ Aquifn.Storage and Recovery . DSalinity Barrier -. f TO MATEMAL EMPLACEMENT'METHOD • Aquifer Test C11StormwaterDrainage ' /A ft. erimentalTechnology DSnbsidrnoeControl ' ' M ft. ft. -' Geothermal(Closed Loop) DTracer - 20.DRILLING LOG(snob adrift d se tsMammary) Geothermal aleating/Cooling Return) r)Other(explain under#21 Rotundas) e� TO r taaamr.:ann.etR ante:sea ems) tz , 1nrS0ii 1 4.Date Well(s)Completed: ao �"� Well IDP — I tt. I 0 fz Bengt l r�l G I NV Sa.Wen Location: 1 6 n' 5-C) f 'So*j bro lc r r 4 C K ` -o.cc b Tkc,l�o.J'.rOi. 510 ac ft. To c.' :1 — v f.7 Facility/OamcrName Facility m#(ifappticablc) - f It. •---. •i i,: Q.°\ Thor. sun \rJO' 1 C➢` ftrd a-‘ SE5' ft. ft. St!' C 0 ZOZ4 • Physical Addtess.CuY.and Zip Cy •, Ir,{�:'P'u:t's•a'?r. �ve�-.�i tear rN AV'',It) l����9��.5a. J 3 21.REQMARIIS Nfl:r a.0:- County Pascal ldeatilcoionNo(PIN) - 5b.Latitude and longitude in degrees/minutes/secends or decimal degrees: , awed field,ono ladlongis sufficient) 2 �^•l G 22.Cron: I jd a�j �! " N ��° J I / d� 0 'l W ,} �-, AAA �rm�o�a,^ 0 o�� &Ifs(are)the wel(s),Permanent or - 1i' Wdl Coatrae Due By sntaa this forts.I hereby sere time the ndf(s)was(we)rnnstrruted is accedence 7.Is this a repair toandwelt QYes or 474No with1JANCACO2C.0100arIfANCACMC.OZUOWellCoafrualonSimila►draadtheta . OihtrLsa mar.jilt out knownwelIa lanisfennationarulapls&thenatrreofthe colaNfhirremedkm been ptovFdrti►otrew&owner- rrpaktuutert2l remadessectimt neon the backtithtsfamc 23.sllte diagram or additional well detntls: 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well "emotion details-You"'also each additional pages ifnecesmcy. consttuctiogonly 1(tWl l is needed. lndita+leTOTALN(JiuID}sRofwells a ; I R7 O NS 9.Totalwelld�thbeknvlandsur " � � 1) 24a.For Al Wells: Subrntj this farm within 30 days of completion of well Fbrmai*wells l sta,Ide the rdlmant(a 8®IQO end2600)- e on to the following 10.Statism:aer level below top of casing: a (ft) Division of Water Resources,7nfbrmation Processing Unit, !finger level fs above easing.we+- 1617 Mail geeviee Center,Raleigh,NC 27699-1617 11.Borehole diameters (m.) 241),For infection Went 'In!addition to sending the form to the address in 24a 12.Well construction method: t �-�0 0.f above,also submit one copy of this form within 30 days of completion of well (Le:auger,ronuy,cable.ditectpusb,etc.) CtlnsnataiDn>b die following Division of Water Resources,Underground Injection Control Program, FOR WATERSUYPLY WELLS ONLY: 1636 Malt Seivlce Center,lalelgb,NC 27699-1636 1, 13a.Yield(gpm) I+ Method of test c3ONSYs 24c.For Water Sunaly&jnteetlon Wells: In addition to sending the fame to _ {� { the adti (es) above;, also submit one copy of this form within 30 days of ` 13b.Disinfection type: 1� 1 t 1 Amount .1- 16 i ' completion of wall conguiction to the county health department of the county when conslucted. , 1 P,mnfW-t North CemiinaDeo eanent of Envinenneniel Marne-Division of WaterlesTie= Revised 2-22-2016