GW1-2021-01556_Well Construction - GW1_20210309 (2)

i.Nell Corltractorinformaafln; ForintemalUse Only: -
Chris Morgan
%Yell Contractor Name 14.W4TER20NE3.
3572 rROatTO
y 1 ft. DESCR1PTlOi4
\C%Ye11 ContiactorCertification Number �b��� /% 2021 R'
Morgan Well&purrs .
p, Inc. Unli.
Company Name ^ftila��'nProcessingolt R Omee rmalttcased�vclls ORLTrIRR fn livable
D1A1tETER T�CfQVESS
+1 it, ft. 12ATERiAL
2.Well'CoDstruction Permit ig: 61/B r°' sd21
ListallappUcahleaenw2rlruction a i6.INNERCASINGORTUBING PVC
P rmits .e:01C.Caragr:State.Varianee.etc) Pnont TO (eothermal closed-too
DLt11EtER TItlCtitVL•SS
3•Well Use(checkwell use): n' ft in. 1ttTERIAL
Witter Supply Well: EL R• !o.
Agr'iculturdl 17..SCREEN"
Geothermal(Heating/Coolin � rMunicipaPublic Mont To Dfpi►1ErER
$SuPP1Y) I�'l,i (Residential Water SPAY.(single)u ! SLOCSIZE
Industrial/commercial THic[rnEss IVMTERIAL
" 1°'
QlResidential WaterSn i (shared) ft ft. !n.h1i ation PP Y(shar in.GROUT.Non•thrutI Suplil 'Veil: 18-GrRO5 ro
Monitoring 1tATElZtAy' C1iPLACg1iEPtTl1g.rH°Dganiotm^r
o A. 2a ft
I1�jeCgOn V✓eli: �IRBCDt'Cry hentonite
Aquifer Recharge ft. It. poured
E)Aquifer Storage and Recovery MGroundwater Remediation f• %
Aquifer Test Q1SalinityBarrier 19.S AND/GRAVI;hPAQC ifa livable). "
Experimental Technology
(�'�iStormwaterDrainage FRO1t TD NIATCRIAt.
ft ft. eatrLaCrntsrrTnreTrton
Geothermal(Closed Coop) �1SDbsidence Control
ft. ft.
Gcothcmtal(Heating/Cooling Ret� DTracer
20.Di2ILL[NG LOG(attach additional sheets If necessary.)
. Other lain under�21 Remo 011 rks) TD
DESCRtC!(ON color,hardocu solyr,crt t 0.erata sac etc)
¢.Date bVell(s)Completed: fr• q ft.
�� wenrDi:n/a /V
Sal. ell Location: 5 tt' 6 D ft. 1t/✓► tY
6✓dxve �n;-� t;t 7;oiln alit (Q ft. 7 S ft.
Facility/Orvncr Nnmc � fr• ��� ft_
Facility iMR(ifapplicable) ft
�'
phys'calAddres� Cr andZrp /V� T8�?� ft. ft.
2/,7? fr• ft.
County n!a a1.REN1l1RICS
Parcel Identification No.(piN)
5b.Latitude and longitude in degrees/minutes/sec or decimal degrees:
(if well field,one lat/long is sufficient)
22.Certification:
6.Is(are)the wou(s) er'maa T
QI_emporary Signature of Ccrt �
ent or I G` /
2,6a Well Contractor
7.IS this a a fill on an Bp slgiring tb/s fora.I lrereby rnrt %bat the nt Ills)runs 6-re)constn cted in accordance
P existing well: QiYcs or ;AID
Jiba is n repair fill wrl6�toun well rnastnretian infonaation and mplaln/Ira nrarrr a of the a PJ'01 thiDate
s record bits biter provided to the uv 11 onner.
repair audar;.21 rentarkr sectlon or on lire ban-ofrhisfontt G1 C 0_C s b or vi d to /,03C.02I10 Nell ConslnrcNan Standards mid drat a
3.For Geaprobe/F?$T or Closed-I p g 23.Site diagram or additional well details:
Sao Geothermal Wells baE the same You mIIy use the back of this page to provide additional well site details or well
construction,only 1 GVU_i is needed. Indicate TOTAL
drilled: ' NUMBER of wells construction details. You may also attach additional pages if necessary.
9-Total%;ell depth below land surface: `��0 5It'3i 1i� IN
S TRUC7IflNS
Pot nnrltiple uVils list aft depdts I'd ffl,,jr(eram le-3 ('') 24n.For All Wells: Submit this form within 30 days of completion of well
P a�_00'aad2r�iti00�
10.Static water level below top of easing. construction to the follDwing;
lrattrer level isaba�ecnsiug,nsc'•+•• (ft•) Division of Water Resources,Information processing Unit.11.Borehole diameter: 6 1617 Mail Service Center,Raleigb,NC 27699-1617
Cn.)
rOia 24b.For injection-,,Veils; In addition to sending the form to the address in 24a
72.Well construction method: fy above,also submit one c
(i.e.auger,rotary,cable,direct push,eta,) construction u the fone copy of this form within 30 days of completion of well
FOR WATER SUPPLy RT.LLS ONLY. Division of Water Resources,Underground injection Control Program,
ti(
13a.Yield QPm) to 0 1636 Mail Service Center,Raleigh,NC 27699-1636
Method of test: air pressure 24c.For Water Sunniv&injection vWells: In addition to sending the form to
13b.Disinfection q-pe: granular the address es above, also in 30 days of
Amount: 1. �Z completion of wellconsuuctionmtotthe county health d partmeOne copy Of this form nt of the county
where constructed.
Fon»G%V-! Noah Carolina De
partment of Environmental Quality-Division oflVater,Resour,es
Revised 2-22-2016