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HomeMy WebLinkAboutGW1-2021-00304_Well Construction - GW1_20211229 SELL CONSTRUCTION REM` r� For hltmn l Use only: L WeR Contractor Inforendo= _ L. S R •C inn 'e7777 IawerERzotaes... ��: Wea COOMMI orNme _ F80M Tp D 'IIOi1 5 3 5 0°R' ao� NCweIlCo�eoorCepSeN�� !i g /`'�lla�-rnal ��•!�; -ss,ovrEae�.�rc s��to-�::�a. oRLn� .M�._•_. . �..it/�- F7tOM TKO DIAb>� �q wa•r�v.�._ Comp®p�Neme - /� Q� $ 8 is 2•We1lConuetionp mttp: �/ �✓ 3 Z � 1-0i MIIIItBRG1.SQiGORT�7NG a> =w r.. •t` •ro Diensast �ona:s ' ics•�ui... LtoaacppilcableveIIa 1—itir it-LaG C-Mw.Smtt;r,,, ,cta) -F ti 5 S 7� m I C ✓L 3.Well'Use(Check well user m, WaterSq*Wea: ;,tI7. '.r. -�. `•:'4tsilr '.-'` n � :.'yA't:.'w' �i=;.w ..". OAgl7�al PROM TO •; DIAMUM I S=S= I THIMPM MATXRTAL 8 S 1 . "Geothermal m-tMOCoohng Shy) AR-deabal WatwSupply(single) 8 m O7adr:stiaUCammatial OResideatW Water Supply(shmd) fl oa OWells>100.000 GFD K TO: •-:° 'y a.~�v: 2�>:'u4 :::`=c< UlMMAL •':••:,•II1�IA(�®YPMELIdDtAIi[OmRI Noa-Water supply Weil: R G�a�' >l. ORecovay Injection We R$ r+t,.-• O Rerbffi8e OGrotmdwaterRemrdiatiaa $ fL . OAgmfa•SwM pandRecovety IISali*yBarde SAbID/(RtA�BLPA d `ar�u�.�_. ' ���� -,•, • mtomCLAquifir TO MAZSttAL II1�FA rt�6D Te3t ,QSW=wzterDramaga s R OPxpecmaorel Tecbnalogy OSnbsjdeace Control S ft OGeotimmal(Closed Loop) aTraCel =20.`DBILLIIdCrI.Ot` s ehi8ditiaaLLsleeei "" .r .�. ". OGeath®al(Eeatfug CoolmgAgum) OO&C(aphu under#21 Rcu m is) ZRoK To $ Dasaan ort Y.ir�.et �a� 4.Date We11(s)Completed: Z- �� Zt WeIl ID# R 59.Well Lolafion: - & ft tiPr'f S C. Facr7ay • N®e P-My Mo 9 PP>kame) fy g s $ Plyaal Add CitS.sadZp !t 8 d G»- :2i.RF.D7AB&5: . P=Cd kkwWwadwNo."D r 5L Latitude and longitude in deprees/mmates(seconds or decimal degeen Czewenfield,Cm lydloagis-Mci at) 22.Curti& 'o>r �� I2.zv -I'l 6 IKSM)the wws): permanent -or OTemporaty /,j y o Sigaaflme ofCaffiw 6Vel1Co y Dow BYjfVz+S°&f-n4Zh_hycv*d=r,xwcfis)wmhas)amuskscmdniacmilwww Ai 7.1sthisarepairtoaneistingwelt- O,Ycs or ft-16— 1UN=02CbI00m•1SdICdCO2C.0MVeQCVzvz roaSmn:Jv z1Jzhaoe0py Ifa�drbasrpwr,�IIwiimor�weIIaooneretlarb+J6saaalmrandagifapsrhefs�o:ofthc ofrhistr.+cmdhmbeorlevvfdrdmfhcHrdownv� •repatrsordertr2ll amLtseatanoroalLebarPofllYcsforns Z3.Sdediagaatorad�tfoaalwelldeta� S.For GeopcobdDPT or dosed Loop Geothermal Wells&ft the same You�'use*e back of this page to prude addjHal on well ammfzr cd=info wasttuction,,aoly 1 GW-1 is needed.Indicdte TOTAL NUMBER ofwella (add'See Ovee&Rtmiadcs Box}.You may also attach adOmW pages ifnecemy. dulled: 2 .SUBM3I7ALXWERUCHONS . 9.Totalwelldepthbelowlandsurface: off+ g ForV=tdpfsW.&Bsraadeprlrs►Ja4fb„a(Cc=J' -3@200'mrd2@100) () Submit thisGW-1 Tv 30 days of well completion per the Mlowing: 10.Static water level below top of eubW (a 24a.For All Wells Ong'mal£omt to Dzmm of WaterRasmees (DWR). tfwmetlendtso3o►eem 'tve"I+�- ( ) I ouPMce=*Uhk1617M5C.Rsleigh,NC27699-1617 11.Borehole diameter. �o / {m.) 24L For Injection Wells:Copy to DWR.LTadagtamd lWeeti6a Coattol(1UC) Pmgrdm,1636 MSC.Raleigh,NC 27699-1636 12.Welt eonstrdefion method:_)< o")c'-�Ar�• G CiG a�a �k diratpntiti eoC) 24c.For Water Sumo and Otrea�LooD Geothermal Refum Welts CopytD the ".. oou*envi-r-m-meMiealtbdepmum=ofth-CO=IyVA=MS=od FOR WATER SUPPLY WELLS ONLY: , 24d.For Water Wells mvduci over 10 000 GM.Cogtd.DVIX CMA 13a.Yield(Zpna) 7 Method of test Pffmzt Pmgtam,1611 MSC,RWei C 9 1 11 M DL*&ction type Amount Cti FormGW1' North Cam]=DepmmoeocofFa—===Quality-DivimofWatrrRes ma Revixd6-b201g