GW1-2021-01289_Well Construction - GW1_20210329

1lO1VRECORD GW_I
For Inttnn
I.Well CantrcrorInformaDon: at Use On y
Chris Morgan
R'cll Commcror Nam, 14.IVATERZONES
3572 AT 1C TO RDcscatrno y
NC Well Cannacte,Cmification Number R• ft.
Morgan Well&Pump, Inc. 15.0DTnn CASING for maldeased wcW OR LINER r
Company Name FRO.% ro DWIETER •HIC MATERIAL
+1 R. it. IINFSS M afRIAL
81I8 in• stl21
2•Well"Construction Permit#; ` FRONT GORTUDIA51 anthermalclosed-loo Pvc
Lltf all app(knh7e cell ronrf'ny7an RtOM1t In DL1h1EfER
Pa'ntar(o U1C,C "J'.Stale•rarlanca,etc) R THICI(NeSS AIATGRI`I
3.Nd]Use(check well use): n• 'a
Water Supply WeB: ft. R•
IZSCREEN
Agricultural DMunicipal/Public FRONT TO DUN ta'ran
Geothermal(He 1 R. SLOT SIZE ICrOeSss nrn
S Supply)Y) �iRrsidentiel Water Supply(siaglc) m to
IndustriaVComme¢4al Residential Water Supply(shared) ft R. In.
Irli anon 18.GROUT
Non-Wuter Supply Well: FROhl a1ATe1WL
0 R EAIPLACEI1fEAT afETFtOD@ANOLI r
Monitoring
ction g m iL bentonae
Injection e1L• Recovery poured
a D.
Aquifer Recharge fr�GmundWater Remediation M
Aquifer Storage and Recovery Aquifer Tes[ 19 SAND/O�
Salinity Barrier VSL PACK ifa Itcablc
FRWt ft. TD rL atA'rERGL CAIPLAMIentt
['IStormwaterDminage r3=11OD
Experimental Technology II----�I,,
Geothermal(Closed Loop) 1_PSubsidence Control
tit.
[],TracerGroth cnnal(Heatiga.,/COoling Reams) . Other( lain under 21 Remarks) 20.D1trr.LfNG LOG(ottncb addl8oaal sheen tfaeccssan•)PROaI TO DFSCRIPr[0.\ trolo,hwda
r1 O @ us.soiumdtm sbaehl
4.Dam Wells)Completed: _k0II_ 11 Well ID"n/a ij R. ,r
Sa.Well Location: a--- 0 ft.
(, R. %WA `rV
D ft.M EeS�er n/a
FocJrry/01Ynw Namc �—
ifa plitabic) R`
FaciatyrpP( �O R.
367a n h 1P �c
C �DJ(/ fL
Physical Address City and NV On ft.
Lfr
/��ll fr. g•
N•�Q,ffVs n/a 2L REMARKS r
County
Pamcl ldcatifiention No.(pnr)
56.Latitude and longitude to degrees/minutes/seconds or decimal degrees: M
(ifwell fie)d one Ia�V/laag a suificicnt)
3� K�7 S0 Z `y 22.Certitieatiao:
t•t ©. Z248 f�tlnlarmatienPracessingUnit
DWR Section
6.Is(are)the weB(s) X Permanent or QlTemporary S Saamu otCem6Ed wc0 Canunctor
C, Dalc
7.15 this a repay t0 as existing NeII: DYCa Or XQNO Bf sthming this forn,/ltambJ'mrtj(y riot the onl!(s)nos(weal motstmned in acearr(nnre
(this it o repair,fill out knoair'rell rownatioo infonoatfan and ca lain the nanm ofthe c hill'
15A A`f4C 02.O640 or Pr1.1 AICAC 02Ca.200 Well C."noeltun Stondordr and Jmt o
'Mail lode,-21 ,o arkT sectian or an lire baet ofthisforni. p
S.For GeoprabelDPT or Closed-Loop 23.Site diagram or additional Well details:
S.Forcti y oop Geothermal Wells having the some You may use the back of this page to provide additional well site details or well
On,Only IGWtl is needed. ladicate TOT.4LNUMBER ofwclis cOmeruction details. You may also coach additional cages ifnecessary.
drilled: ' 1
9.Total well depth below land surface: 6100 SUBIY1iTTAt MSTRUCTIONS
rertadtiPle uvllr tilt andaudo-T,peroa(emmple-3Q20a'and1Ql80) (N 24n. For All 1.1ells: Submit this form within 30 days of completion of well
10.Static h1'ater level Lelolr rep of casing:_ Q construction to the following:
ilnuter let-at it aboty mahob.,are••+•' A) Division of Water Resources,Information Processing Unit,
11.Borehole diameter• 6 1617 Mail Service Center,Raleigh,NC 27699-1617
On•) 24b.For Injection Wells: In addition to sending the form to the address in 24a
12.Well construction method: rotary above, also submit one copy of this form within 30 days of completion of well
Ge,aeger'rotary,cable.dirge[Penh,etc.) construction to the following:
FOR WATER SUPPLY WLrLLS ONLY: Division of' ater Resources,Underground Injection Control Progra To,
13a.Yield(_pm) Method of tesr air pressure
1636 Mail Service Center,Raleigh,NC 27699-1636
1—�_
24c.For Water Ormly E injection Wells: In addition to sending the form to
13b.Disinfection type: granular the address(es) above, also submit one copy of this form within 30 days Of
Amonnt: —10 completion of well construction to the county health department of the county
Where constructed.
Fort OW-1 North Carolina D epar[ment oF£ayimamenrah Owmm'r- �
Revised_v 22-�_016