GW1-2021-05804_Well Construction - GW1_20211025

WELL CONSTRUMON RE GW-1 J ForinterwUse Only
L Well•Contractor Information: "
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Well Nme / FROM Ta DbSCRIPMN
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NC Well C*=icwCatdic�Number MOUPSRCA.4ING fm°mniticasidwe@a ORLII!TBR
FROM To DTAD�rSR T81C MAI14tiAL
C=PW Name
16�IIVNSR CASQIG'OR
2.Well Construction Permit ft 1 �I'f 3 FROM To D1ADar1CR r 7101C30=13 1
LCtt allcnble rrA oaraarcrlaa permttr(t U1 camrp stMq varanx uaJ -{-1 R 3 R (� to r e t•— 1/t�
3.Well Use(check we truer R R ;a
Water Supply Well:
FROM TO I D1AMttTlOz SLOTS' TI MATIIttAL
DAgncultural nMunicipaVPublic ft. R io.
nGeo*em l(Hen wr4olmg Supply) 43demnal Water Supply(single) R ft. in
OladustriaVCommerciat nR=Aential Water Supply(stated)
&:GROUP
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Chrization13We11s>190,000 GPD FROM TO MATERIAL l3MPL►CZMM4r1118 teesovrn
Non-Water Supply welh 0R R r -e
nMmitO oRecovery ft. R Rv( An L
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Injection Well: IL R
nAquiferPzd= a OGroundwaterRemadiation
nAquifrr Stomp and Recovery : SAND/QtAS?SLPA >a-- •- >�. � ,:��.._ � _.,_-;
nSalinity Baaier FR FF OM TO MATERIAL �FSIQFAQMII"1't�9D.:�+
Mquifier Test OStotmwater Drainage ft. R
nl3 aimetteet Tec>modogy ❑Subedenc a Control R R
00coffiennal(Closed Loop) ❑Tracer -2tL DD*'*,**G LOt;atlaeliadditiaaalislieefs'if' - -
13Geot�tal Paun) 00d=( uadertR21 Rrm elm) FRtx1S - To DESCRIPTION jowl"* ea:
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4.Date Wells)Completed: 0 ZI Well M# R ft.
Sa WneQ Location _ n ft. R
R R
55Z2- R R Unit
ftysical Apm Cqi =dZsip R R InICrr�,3tton On
.2L:R8MAM:
ear Parcel la nNo.(FIN)
5L Latitude and longitude in degrees/minWts/seconds or decimal degrees:
ofr►aII Se14 one Ltllm is soffideae} ' 22.Certification:
�.Is(are)the welks): 02ent or nTemporary 774 J S'gaamm ofCatified'.WcU Data
� ByApwCftjbm Ih��Art de ndl(s)w=f�14wavacmdbraa+w dm wwt*
7.Is this a repair to an eristiag welt- •QYis or 01Yo 15ANG1C 02C:0100 or 15ANCAC 02C.0200 WeQConvuMn Srmidmdr and drvr a copy
If drlr to a,qm*f v ae lemur reu aoom oda"orforamuan arrd aplafi she nawc ofmc of ddr re=d has boor provided m the nrII oraer.
:rpatr mxter#11 tsauahsearoR or an the back ofthtrforar 23.Site diagram or additional well details:
8.For GeoprobaMPr or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well cmtswxtion fi&
won,c*1 OW-1 is needed-In&cdte TOTAL NUMBER of wells (add'See Over'm Ram BoxJ You may also am wb additional paps if necesmy.
24.SU MiTFAL INSTRUCITONS
9.Total well depth below land surface: y"26 1 (f) Submit this GW 1 within 3o days of wen completion the f
Porn uUfple we&Harall d9d-tft84imrt(aanrplo.3 00'4ad 2@100*) ys mp per ollowhW.
10.Static water level below top of easing: 0 R Us. For All Wells: OnSmal form to Division of Water Resources (DW4
kwatts atimr I.+% ,/ ( ) )aSo>mation Pmcessiag Unit,1617MSC,Raleigh,NC 27699-1617
1L Borehole diameter. G 0 gym,) 24b.For Injection Wells:Copy to DRY Undergound hiection Control(IUC)
n Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: I�0+&R-r — /�t s✓ 24c.For Water Sn and O n�Loo�Geothermal Retina Weller Copy to the
(ice anger=°°°1,`'tile'daeRpmb,etc) cwmty envanum health epactrueat atwe comely county
FOR WATER SUPPLY WELLS ONLY: Z4d For Water Wells rodn' `over 1 GPD:Copy to.DWR,CCPCUA
13a.Yield(gpm) _Method of test rY' Permit Pcogam,l 11 C, 1 11
13b.Ditiafeetion type: -� ' Amount:
Ferm GW-1 Noah Carolina Department ofEnvuonm=tai Quality-Division ofwater Res== Revised e-6.2o18