GW1--06292_Well Construction - GW1_20241022

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: '1 .
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1.Well Contractor Information: . y �y� yg' q7 x fit;
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- FROM TO A ft. . DESCRIPTION
Well cg ii me ,
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NC wen Co for tlonNumber O 11tt ir'tt ' :w 18 4; :wry: , h "' ,
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rt eiil�E��i- •61 aunitlI , FROM n TO . UTAME7SdR fie I/4 in. Tffi . ... ��li� /�1t ze '
Company Nam w . ; ._.. - .- 7 r'''.
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2.Well Construction Permit#: -ail- (log q�.� • FROM TO DLUMETER Tm MA '
List all applicable well construction pant/is(I.e.UWC County.State,Vari dos) R ft. j in.
3.Well Use(check well use): ft. fa 1: to'
Water$upply Well: MO(.zw:s-w "..r tr �n r.Il' P''' �6'e. '_`Vi "y'`'"`i,X"'it y ;'a s �7 �''. ` f '
FROM TO DIAMETERI •SLOT ME CXNESS MATERIAL
OAgricultural CI ,. cipal/Pubiic ft. ft. ° in.'^ ,
❑Geothermal(Reating/Cooling Supply) r •-•dential Water Supply(single) ft. ft. In;
DlndustrlaVComme cial °Residential Water Supply(shared) �• d r 4
��'�:";,?'�a>i�.,�',.� - rti. ��4ic �;. �'�e`a�ci�''A��:�, `',�.'s.,�'�:�.tn5's�Efs'��'�t r:. .
ClInigation OWells>100,000 GPD FR M TO t,MATSRIAL 1 reinM: :1-+ MOOD Si AMOUNT
Non-Water Supply Well: C) ft, 2.0 O' b.e, l k of iztt '
°Monitoring ORecoveiy ft. ft. c.f
Injection Well: ' -
ft. ft.
Manlier Recharge OGronndwaterRemediation
OAgnefer Storage and Recovery CISalfnity Barrier FROM TO MATERIAL EMPLACE OD
0Aquifer Test OStorxnwateri?rainage it. ft: .
°Experriimeental Technology*o OSubsidence Control ft. f. �.r �i
DGeothermal(Closed Loop) °Tracer �:10!:9s,� 2.'• 4•_•i:, li dthiet ,+ a�'Y' ii ��x �
)Geothermal(HHeatind/Cooling Return) °Other(explain under#21 Remarks)) FROM TO DFscRIrTiON ter,bantamoWreek tsp..ism r
4.Date Wel(s)Completed:f e. d- V Well ID# So t. (0 0 it 6.'fife, rOG ,
sa.well(Location: 1 0( it /ic0 n' �j i^d IU�''e:�-�0{�KE`
619r. rell . ft. ft. '•/ irit f,..,-...c.,i,L...,; ,.? .,..-...,..,,
Faollity/Owner&are F ID#(if applicable)
�' r OCT_ '!r [024
1114 Bear. ( th IA. A4tdJkcLX a15g`1 . '� • ft. �1t.,,z1
Physical Address,(Sty,and Zip ' I It. ft. Ire`,: E.`�, _' s J
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County Pared No.(PIN) !
Sb.Latitude and longitudesin degrees/minutes/seconds or decimal degrees:
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(ifwellgeld,one Lallans la sufOclent) 22.C a .si•'don: ;
N W /14/k' er(/ tat I A r'D - 22- It')6.Is(are)the well(s): i>�ermanent or OTemporery S:-.:.,,:f Certified W Contractor DatD
�/� ByslgningMisfarnt,I hereby cart*that thewell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: DYes or 6No 15A NCAC 02C.0100 or 1SA NCAC 021C:WOO Well Construction Standards and that a copy
ythisisarcparifill out known well construction ttlibnnallon and explain Me nature of the ofthis record has been provided to the ll owner:
repair under ti21 remarks section or on the back of dis form. 23.Site diagram or additional well details:
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8.For GeoprobelDPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
constiued%only 1(3W 1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages ifnecessary.
drilled: 8 d 24.SLi33MITrAL INSTRUCTIONS
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9.Total well depth below land surface: (f�) Submit this GW-1 Within 30 days of well completion per the following:
For nnftle wells list all depths ifdt•fferent(example-3(a)aW and MOO')
24a. For All Wells: Original farm to Division of Water Resources (DWR),
10.Statle water level below*top of casing: o (ft) Inibmtation Processing Unit,16171MSC,Raleigh,NC 27699-1617
Ifwater level is above casing,use"+•
�l� (in.) ' 24b.For Infection Wells:Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter:
� Program,1636 MSC,Raleigh,NC 27699-1636
•12.Well construction method: air ro p %; 24c.For Water Supply and Op IwLoon Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county envimumeatat lrealttdeparimetit of the county where installed
FOR WATER SUPPLY WELLS ONLY: f r 24d.For Water Wells prode Inca gl•o I er 100,000 GPI):Copy to DWR,CCPCUA
b!0 Permit Prograim,1611 MSC,Raleigh;Nd 27699-1611
13a.Yield(pm) .J
J,, Method of test: j 1
`13b.Disinfection type: ht Amount:' 1.� 1