GW1-2021-01308_Well Construction - GW1_20210329

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R-.�OIiD GW fl
t,'ell ContractorInfonnation: For Internal Use Only: "•
Chris Morgan
hell COntmemr Name 14.%,LTERZONES
3572 moal TO
nFscRlertoN
R. R.
NC well etor
ConlmCeniticadon Number
Morgan Well&Pulp ft R.
p, Inc. ts.oureecastnc rormwa<asea,veas oR
company Name rR0°I TO MA ETER f.1NER to 11=11,e)
G tt ft. C� fL TffiCIINEgs MATERIAL
2•Well"Construction Pe T 0% -oS� r7 6t/a • sd2t
rmit#; 16.INNER CASING OR 7T1E1NG puc
Girt all app((coh(e"'ef/cwrrrrtrc(iars FROn1 (eatherant davetl-Too
peon r f U/C,Caaan.Stale Yarirsnce,efttf TO DIAMETER
3.Well Use(chechwell use): ft ft. 7RICHINJI i11,1TERIAL
Water : l W in.
Y ell: rt• R.
io.
Agricultural I-t, 17.S CREEN
Geothe I_yMunicipaVPublic rffonl To Fur Commercial ooling Supply) It 1nMErlm st.or slZE TRIctO<E55
�lndusMallCommcrcial �I$csrdential Water Supply� ft• is "LtTERreL
(single)
DResidential Water Supply ft ...Im anon PP Y(shared) ;n.
Non-Writer Supply Well: 18.GROUT
rROnt TO
Monitoring Al EnirL.tCEn a R. Za R 1t¢JT AILTROn&
LlJeetlon Well: t_PRecovery hemonae poured AMOU1T
Aquifer Recharge II''--tt ft R
Aquifer Storage O''Groundwater Rem R
ediation ft. .
g and Recovery IS¢lird B 19.SANDJG
Aquitar Tes[ � ty a1T1er RAVEL PACK Tr
tfa
Experimental Technology Iicablc)
�IStOrmwater Drai FRONT TO I -nage tAL
ft. ft EnIP"Crnrstrr Mrraon
Geothermal(Closed Coop) DSubsidence Control
QlTmcer ft• ft
Gco[hcm)al(HeatinglCoaling Return) Other(explain under d21 Remarks a0 DRILLING LOG(am h addidonw she Is g¢e
4.Date )FliONI TO
q 7 D CmCrlON colN,aard°egsNlOrochlr e^ In s'"q Ne.l
Wells)dompjated: 3 ft. d R.
Well ID#n/a r
Sa.W I Location: ft.
6 ft ft.
fotun .'�
LA tk>z+g so, nla
Facilivown rNamc fr. n.
I:�C-40 r IIIF 1Try IDp "f R
applicablc) ft. ✓tip
.
V y R.Phy al Add s C t) and Lp ft. _
Ltr7CO\A ft, ft
County (2' 21.REMARKS
ramal
Sb.Latitude and longitude in degrees/minuteslseconds or d c`timnl y
(if wdl held,on"lndlong is sufficient) degrees:
G 6g3Q p 0 1Q S ;7Y Q 22.Cer iFcatia": _.
ry^ 1 C. ,
6.Is(are)the weR(s) pprmanevt or
OTemporary 5 goal fCcnif6d 1VcIi C ao Imctor I• 14i
7.Is this a repair to an existingw 3Y signing this r"at f hereby""'yy r/,a,f/,a uxl!s ryas(mere!c'OrDat cfed in arcm drain.
/flhis is v repair,f/f outhno�yr tvclf ro sm �Ycs pr �plp n'ilh 15A A'C4C 02C.0100 ar ISA NCAC 017.0200f1
repair under�v nhe bad,�fianrthlsfmfion and erplain The"more oJ(ba 000J•oflhis reeardhar been pmvlded fa the twill uumer.
P l remadT,rac/inn or on The bad, f ffonl iann. Nell Consfntcfiou Slmrdmdr unit t/rat e
g.For Geoprobe/DPT or Closed- 23.Site diagram or additional well details:
construction,only I G V- L. I Geothermal Wens having the some You may use athem back of this page to ai
A Y } 1 is needed. Indicate TOTAL NUMBER ofwclls construction details. You may also mach additional pages if necessary.
drilled: ' 1 / Provide additional well site details or well
9.Total bell depth below land surface.
1 6S SUBNUTT4L INSTRUCTIONS
for mnlr(ple n•ef(s list al(deprlrr rfdderera 1`eWntp1e-J@200'and 20a/00) (F)
242. For All 11'ells•
-�_. Submit this form within 30 days of completion of well
10.Stolle water level Dalow tap of fasin construction to the following:
I enter/ere!is above r.•nrhtg,rite"+" gconstruction(ft.) Division of Water Resources,information Processing Unit,
11.Borehole diameter: 6 1617 Mnil Service Center,Raleigh,PIC 27699-1617
12,iVell construction method: rOtalY 246.For injection Wells. In addition to sending the form to the address in 24a
(i.e.auger,rota above, also submit one copy of this form within 30 days of completion of well
rotary,eablc,direct push,cmJ consuuction to the followin_e:
RE" ER SUPPLY WELLS O"IT
n Division of Water Resources,Underground injection Control Program,
gpm) 36 1636 Mail Service Center,Raleigh,INC 27699-ntro}mthod of test. air pressure
For Water So Iv E 1mectiOn Wells: In addition to sending the farm to
ection type: granular the address(es) above, also submit one copy of this form within 30 days of
Amount: 0=_ completion of well construction to the county health department of the county
where constmcted.
Form Gw-1
North Catalina Department or Erwin n nenmi Qmlity-Division of Water Resautcas
Revised 2-2-1_2016