HomeMy WebLinkAboutGW1--05818_Well Construction - GW1_20241001 \\EliO\S 1 Rl l 110\ RFC
I?F2ll (i�1-� Tor IntcKtta!'tfvr!MI: -- -
1.11 ell.'anttaci•v lntia
``II lion.
\�!1` "t)tin0
-______ --_ 14.\\'ATFR ZONES
t RUM it) 0)YCR1r1N)"t __
4605-A 3‘0 "- J1.r "- .---[._ _ ----
Well
�3"Tn- NGo "- 3
N `\�. Poole e!t and Pump CO. 13.01 ITFR r 1.W.Mt:(Tor moftl-tart rrellJ OR f t'�F.It Lt•P)lttta6M�
FROM ii nUMF.IFR rilfl"F.'"- lid/►f44,4•
..__. ,.:• .,,,, '�l S "• 183.s R I--- ( --in.] / f� `�Y
l_' 3 In.INNER CASING OR TITHING lm
nthermal t nl-ln),) --
. Well ell('On union I'et'nut k: LAW O paC.'7 -tea. FROM TO nLl t7►1FR -nine K`.F:i4 LAM rra a.
to
... ,. .-•a.1•�r.:r,,,permits(LC E It:.Crli(Ci,St r.,larrance.etc.) rt. rt.
3.\\ell l'se'(Check well use): R R in-
Water Supply W ell: 17.SCREEN
l i::-!:ml:mrai FROM TO ni.+MFTF.0 SLOT SI7.r TUN'.A"r i_cc M.I fRl tt.
GMunicipal Public R ". in
'Roth-ma; �' ,
i.r.athneCoolingSuppl�) sidential Water Supply(single) R rt. In.
:Industrial Commercial GResidential\Vater Supply(shared)
t:1mi n:ion - is.GROLTI
G\Vclls 100.000 GPD FROM _ TO MATERIAL EMPLACEMENT S1 F.T}ipU h l+lt-+!_
Non-Water Supply Weil: 0 R do R ?ffitr7: Tf Erb
=\l.x;toting 0R+xovcry R. 0.
Injection Well:
R. ft.
_.-quifa Recharge GGroundwater Remediation -
19.SAND/GRAVEL PACK(it applicable)
-
Agt::ft,:Storage and Rixaway ❑Salinity Barrier FROM I TO 1 MIATERLAL C EMPLACEMENT MEDICO
_.iauite T st DSiormwater Drainage "- g- 1
_Exnenznen:alTechnolo`. ❑Subsidence Control R R
-tt xhea^.al(Closed Loop) OTraeer 20.DRILLING LOG(attach additional aheeta if necessary)
FROM TO DESCRIPTION(color.hardness,a/Winck reps,grain dsa.•�
_ •
tre.atherrated(Heating Cooling Return) GOdu"r(explain under#2l Remarks) itfto 02 77p-5-c-/4-
4.lne Well(s)Completed: ot)•'13'02‘( Well IN a R 7/ R 5Ary D S t:LA l
:a.Well Location: 7/ "- ,SOS R 6 i t1- /7J < / .5o"rE
R R 5,4ti4)STo n• L..-
AA 1 I c.e_ it_to`
Fa:110.y Cuncr Name J 1� l Facility
)!Da(if applicable)
t. "• •_4..-••�,.. j t_1,,a,,,L.
cluck CteN VGS CA-'. {?.4\�t3lel"L R R nCr 1 Y
.st:a:.icr-css.Ca},and Zip R R �0�4
21.REMARKS -..
t")GN.<<e •Used steel hardened drive shoe • Um_.. , Parcel Identification No (P[A�
5b.Latitude and longitude in degrees/minutes/seconds or deelnail degrees:
.»e..time,one tap.long is su:Iicient) 1( •22.Certification: ^ �}/W:747
C • car 1 lG A' N - 1 b • ("'LA� %Z,' 1V ..tgeC-2_ 4
Signet e of
r•+. g 444C ntra r6.Ware)the well(s). _I(nnanent ur ❑Temporary Da:c
Ry signing thisfermi,I hereby ce ijy that the wells)war(were)eo atrete.1 in.h ,aao... �.,i
Is thus a repair to an existing well: G Yes or ItNo 1 JA NCAC 02C.0100 or 15.4 NCAC 02C.0200 ur.,i Coista anutr aU.,t v,G-PO_h.,..:
z_._s.repair.fill out known.ell construction information and explain the nature of the of this record hat been provided to the well owner.repo.,,.;rr:1/remarktr action or on the back of this form 23.Site diagram or additional well details:
rk.fur Gcuprobti1)Pr or Closed-Loop Geothermal Wells having the same YOU may use the back of this page to gravid additi.nuu twit cruasucv.ut i:u;•
corrsrr cltrr..only I OW-I is nuadtxi. Indicate TOTAL NUMBER of wells (add Sce O'er in Remarks Box).You may also attach e.i titional pager if net.i a.+
dril{. ' c 24.SUBMITTAL INSTRUCTIONS
9.'total well depth below land surface: So J (ft.) Submit Ibis G1V-1 within 30 dayst'well completion Nee maniple.eat 1st all d pNa if idf/ireru(exumtde-3411200'and 2ta)l00'ju p etlull per the follow It
a 4 Na. For All Wells: Original font' tt Division of 11'attt .:w Rxirc.. (I AtR,.
10.Slane Wader'level below top casing:of Olt) Information Processing Unit,loll\ISC,Raleigh,NC?70)0-1n17
1).a[.,le.el is m eve cuvny.u.'•i"
11.Idurthule diameter. bit Ida) 24b.For Injection Wells: Copy to D\Vt,1 adagruusid In)xtiori Coml.,'lit t"
Rotary Program,1636 MSC,Raleigh,NC 27094-lo3o
12.Well construct Ries method: lac.For Water 5u
h c a;gcr rary.:ahlc,uaecr pu:h,et,i ppI curl Open-Loop Geotherml Return Nrlla:Cup.to pl,
e.autlV uiviiumttuital hwilh dcluutlilcnt of the eouruO what ivatallal
FOR WATER SUPPLY WELLS ONLY: 24.1.For Water\lrlla lnwhr'IFtg u+cr lUU 11W I;YU:Copy toDWI:,Ct YCL I.1
13a.Yield(gpm) Lr
Method of lest:BlOW Permit Ptograui,lid I MSC,Ralciyh.NC?7n).-tell l
.
13b.Disinfection type: Amount:
t:
Form OW-I North Carolina Department of 1invurorunenial Quality-Division.1 Water Resource: Revised 6.6-201 F
1