GW1-2021-00595_Well Construction - GW1_20210205

vvjL'CONST RUCTION RECORD (GWV1) use Only: _.
L Well Contractat-Informatfon:
Chris Morgan 14 1vATE1tZONES
(fell Comracmr Name mOa1 To D6C'RIPI'ION
3572 ft. i11"It IL
fL
NC Well Contractor Cenifirntion Number 16
Olrr[R CASING for mulct-eyed near OR LniaR Ir�ble)
Morgan Well &Pump, inc. MOM T DLOTTER 1'mCraess auTSRUL
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Cumpany Name *1 "' `0 Ft' axle in. sdr[t
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l `� 16.INNER CASING ORTUEMG(eothetmdCimed-Ioo L,W01fCana le Imilc Pell am moos To DraaIEfER THICICNESS
List ol1 appllrnhle ael!mnrmmfion penmv(r,e UlC,Counq'.State, f'annncr:rrc.J R R. is d1A7FR1AL
3,Well Use(checli well use): n, rL to.
Water Supply Well: 17.SCREEI
Agricultural Municipal/Public Mal To DWatlrER SLOTS[ZF THICI(NEss au
Gmrhemlal HeatlnLIN IL TO
Ill.( g/Cooting Supply) Water Supply(single)
BIlndustrial/Commercial It. R. tn.
QlResidential Water Supply(shared)
hrtgation ID.GROAT
FHOat To afATBRW, aMPLACamEH.r.avaTHoa m Antourcr
10cothormal
•Woter Supply elf: n R m �
onitoring Recovery here rae poured
enon Well: ft R.
quifer Recharge Groundwater Remediation fL H.
quifer Storage and Recovery E3Salinity Barrier 19-5 /C'RA�•PACiC(if applicable)
mom AfATERttt FMPIACP.a1FM maTHtm
quifer Tes[ �StormwaterDminage R ft.
perimental Technology DSubsidence Control R fr
eothermal(Closed Loop) rr••��,�Tmcer
I-P 20.DRILLING LOG(attach audio mal sheets Haecess )
(Heating/Coollo Return) Other(explain under Ml Remarks) FRoal To DFSCRIrnox wlognurdaesr.amvmeal she Net
q W� �—
4.Date Well(s)Completed: (� �'Z�Welt LIY' Off' /s ft.' tx n/a tF s jr H• rx,0ek-2 � r V
So.Fell Location: ell S R. 7o o
nla m m !4r` rw
Facility/ ttNamc L Facility n)N(ifappliablc) fL R
I G616 S4�4CeS �D leSy:l - fL IL
Physical Address,City•said zip IL fL
- e Me- ` 46 SY3SI6e 2L REMARKS
COamy Pamcl h1untification No.(PM
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifivvell Field,am faUlongfis�sulEcient) 2L Certification.
�J .��I► !6 rv ._'C]nP / 7/ / W •J, ��� ZJ cDZ. I.
� Cam,
6.Islam)the wou(s)XPermanent or QlTemporary s'tmamm ofCedtf dweO Contractor pale
7.I5 d115 a repair to an exisHag well: St,slgning drir amr,1/rerebr cent Ural file ae/10)nor( nm were)concfed in arm-dunceYCS or ��7o "id,ISA NCAC 01C.0100 or 15A NCAC 01C.0300 NCo-e11 Cotna:lm Saida d,mid Umf o
fffhls is a repair,fill oullaauR,rvit camunction lnfonnothn,and explain rile autism ofdro mPr oftbis mcordbar been provider/to the avll*I..,.
mpairuader 911 mmarir section ar an the bad ofihisfamr.
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sum e (' all may use the back of this page to provide additional well site details or well
coushuetion,only I QjV-I is needed_ Indicate TOTAL NUMBER oftyyyll���l•t,nstmction details. You may also attach additional pages if necessary.
dn0� 1 1 �2 O <G I " ^ SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: L �j (1 L M fl. All 3i'eils: Submit this form within 30 days of completion of well
Por rwdop/e sells list all depdH fdo'emn(erample-5@?00'and 3 10D')
^\ � ctioo to the following:
10.Static liter level below tap of ra L/lJ
sing: F� •,�(�{L pO Division of Water Resources,Information Processing Unit,
!f'mter Jere!u above eying,arc"+" �y�5e 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (ia.) 24b.For injection Wells: In addition to sending the form to the address in 24o
12.Well construction method: rotary/ above,also submit one copy of this form within 30 days of completion of well
(Le auger•rotary,cable,dilcet push,etc) construction to the following:
FOR WATER SUPPLY LLS ONLY: Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: air pressure 24c.For Water SupRiv F iniection Wells: To addition to sending the form to
granular pp the address(es) above, also submit one copy of this form within 30 days of
13h.Disinfection type, Amount: O 0-L completion of well construction to the county health department of the county
where consmtcted.
Form G1V-1 North Carolina Departmem ofEnvimnmemal Quality-Division of Water Resomas Revised 2-2-1-2016