GW1--06441_Well Construction - GW1_20241101

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only •
1.Well C®tre for Information:'
Jay Toted T2 a4-wA3stz0las;:..�:.c,':,: _ _•_.;:••_-..:._ .•. ..
Weil Cmtrect rxar Fpmt! To • DEZ flt ry •
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it IL
NC Wen CatiBotiottNumber
Morgan Well &.Pump, INC 25:GUIERCASINGRa iiiaLitaiiedieQa)ORIINKFt(II fable) : •''`-,Yr
FROM TO DIAMETER TTnQasES MATERIAL
CCIMPUIPNLim 1 n (�� �- 61/8 '°• SDR21 PVC
2.Well Coast vC1iii1 Paint ft: I,' W 2��Q �� f PROM mvc aRTo>jnveTO D .r ID M -==::MA :;:'::'
TERIAL
LGt all appllrable,rruedvUwKroArmahr ex.fnC Comp,Siatr Yarierza.ex) !z ft la .
3.Well Use(cherlrwenuse):, R.' It fa
Water Supply wen: 17:SCREDI: --i= -t:- .a :1
OAgrieul4ual FROM 20'� enUMETIIt ySLOTEOZ 'ffiCIOCOM JMATEfUAL .
0MmicipiVPubhc It. rt. in.
OGeWhmDal(Seating/Cooling Supply) pesidential Wain Supply(single) ft. ft. • n.
O�TadtLshisl/CoD>mercial CiRaideatialWEtcrSnpply(sbsrod) •lz'V�G[tour: _ :;'•:t' _.;:'x,.:.?•,'� _,::_':,`:ir..:.;_'.':"`.:
oD °Wells>100,000 GPD PROM 20 'MATERIAL ,i..J)<attlAt3ARtTIMIHOD&AMOIMT
Non--Water Supply Well: 0 n 20 It. bentanite poured .
UMorsitw•akieDWg °Recovery • II. rt.
OAgaiferReebarge °CttoundwataRuDediation to
Oda Stomp and Recovery OSaGnityBanier FROM 1d MATERIAL .EMPTACEIIMITMEMOD
['Aquifer Test OStonnwatcrDminagc R it.
. °F.xpaimerrual Tecimology OSabsidence Control ft. R.
OGeotheonal(Closed laop) OTraeer ?20:11IUDINGIACCattieiidffitioiibctilllemTM'):�::'':::;: :•:':-t:-
or---im.m:1(g gpedam) DOther(eaphtmtmde#21Rurd3) PROM TO D m Prekr scOM•sk w,DM.+ta.er.)
7 tj � a. yo � 00 el-
4.DateWen(s)Completed: 16^Z�2I wen Ira o6 . coo `t • cif/!( l J .4crk. ,
Sa.Well Location: I/O tt I ft rGLi�110,06A, ,.;.. :,.' :. a.,/ !, ,i
)i cXt°/ /(eo4e 1 n `:•�:_
135 � �rn��•+e � � • NOV Fea7itylGamerNama FaalGpIDs(if applicable) !L 'ft. d 1. 2024
6e1I1 Trw,, Lflc((ci,d It. . ft.
Phyaied Miters,6ty,ogres D. It - - •,'.•r••,.•.•. " • sj 'tin
0.4
Camay PmclIketiGoboelZa MN) .
Sb.Latitudeandgn loongituudeindeg eedmiinates1ssewQndsCoordecimaldegree= .
cf 5 Zl g!/ )N 3' .QWIt o ` W / /°-2q-21/ .
6.Is(ae)the weh(s):17Permaneat or °Temporary �` f► Wen Dem
9yst ningdrafwzalhmby cad Srthat&wage)leas(rvor)coutrudedfa matdancewish
7.Isthisa repair toan existing well: Ores or eiNo !UMW OZC.O101or15ANCACO2C.02i0 Well Caasn&aSamdar&andthetacopy
.(/'this is a repof,fil cabana,eel!aoastracdan Lffamutimaadcplala As aatve ofthe °fedircmd Alb beenprmidedta th.weltn.aQ
repaireerder tall rtand!saotaa arm the back oftilrfmat
21.Ste diagram or additionalwell detail=
8.For Geoprobt/DPT or Closed-Loop Geothermal Wells having the same Yon tnsy tsse the back of this page to provide t:dditiona well construction info
canshuctian,only 1GW-1isnoeded Iodinate l)DTALNUMBERofwells (addSeeOver'inRemu33Box).Youmayalsoe0arhndd:tt' ipagesifnasssary.
drilled:' •• l'{/ 24.SUBMITTAL INSTRUCTIONS
•
9.Total well depth below land surface: I�� (R•) Submit LidsGW-1 within30 days of well wmpleuoa per the following:
Forarnldplewdlc has ail depths ird ffmst(aapfc-3@200'and 2@100)
10.Staliceraler level bdorr top of min: ill (R) 24a.For AR Wens:Original fo>m to Divlsien of Water Resources(DWR),
Infar:antianPmaumgUnit,1617 MSC,Raleigh,NC 27699-1617
(Nee r Lae 1 is above=sky are"+"
II.Borehole diameter:6 fur) lab-For Inieetian Wells:Copy to DWR,Underg:and Injection Couto'(RIG)
Program,163611SC,Raleigh,NC 27699-1636
I.
12.Weil cods-traction method:rotary
?ac.For Water Supply and Open-Loop Geathtgm$1 Rerun Wells:Copy to the
(le.n:aq mazy,oble.deed path.de) county environmental health department of the rnoaty where installed
FOR WATER SUPPLY WELLS ONLY: 24d.Far Water Wells producing over 100,000IGPO:Copy to DWR,CCPCUA
/oe Method of test air pressure Pcumt am 1611 MSC,Raleigh,NC276991611
132.Yield(spas)
1311.Disinrecd.=type:aanelated.fir Worker Amount:
FramOW-1 Noah Cvorna Department ofEnvitoroxotat Quality-Division ofWaterRuoa=w i Revised6-6-2018