HomeMy WebLinkAboutGW1-2022-00951_Well Construction - GW1_20220107 WELL eoxsrRIIe-riox xEcoc` r,— ForFntemal Uw Onb-
I.Wen contractor informants
WCMCetameptrt� ' _ Md�zot�s...
_ zn �Dssaan�ox'
xcWcnc4Mj6aWc=asc,d=NM=b= R $
ISUUTRBCrA.Sn�IG i�1�E=sedii*Ih O$I�ffit .,,.•;:._•_.
aM� •�'�!�i'`.._v F�M � •D7AbtE� 1�1� MA�7AL
Ca®pimdNeme _ tZ $ is
2.Wen ct>:grualoaPeMlt#: Z0,/ R .5 1L. ����avGORz�Drc' �m c ,=...
To
FROJIQ
Ilsrotf�JpbenEle>reIIa»�Py��IAA�yJ:�t Ymimxq aaJ R R D7eD�•J� TOMNQQ p n
3.Well Use(ebeelcweD Me?. $ $ m.
Da ter sv*Will. ,J17.- .-�•M TO D t,*.'ai.��.a�•:.�JJ.° .`:.. :i=`.aa'K•.'�;'xv'":1�:�.G ' '-'•i.•
OMtmietditblic Iet� STATS z -T1�CB MATJ WL
R 8 m
OGeodxmral(E-(-*C*O&8 Shy) QkMd 1. al Water Sapply(singlo) g R m
��d>r /CO®macJ81 M&d13V& 0nt WstcrSD�y( � .IBMpul r.: +3:'.'> :�'• :s��k- _Rin i=`�;�:�:::'`.- ;
NIoa-Water SaPpIY Well: TO Af&7RRW- I XMFLaCDONrMMOD& OMr
OMonmaUng lVek
OReeovay � �
Cnjectionwa.
-r
°Aqui&rP=bnse OCuormdiv.ner Riatioa R
OAQmfcrStnWzodR000Vezy OSaUlffyBaafez 79.SANID/QtA43LPA :";rsC�3;FSk" :' 3„s+'�+r� <;%
FROM Ms�unL nmwcamtrMs7geD
OAgrsriQ•Test .OSaterDtaiaage _ft. R
O T C ❑SnTisidw=Contra R R
al(ClosedLoop) DTicacer =20 DEILL1rIGFJO�atlSrhiBdifi�Ltsit id ��
OGeothe®sI(SeatmFl�=UnSRetma) ❑Oiha(CPL_ ,Mder#21 Reminds) FSOM To Dascamalox ter, xt :• ;
R I •
4.Date Wep)Completed:jj,2 Z-2 W.0 ID# R R
sa.Well LtCation: - ' IL & e v ear n l-c. t o l'f,-
t.t n C t.y C tY14C F� C V - R R(1h 5
Faality/Ow Nae Fac pII>�(ifappy�hle) & &
P a�s.�aazr p)a w y— F R $ ;JAN 7 202?
C-=Y P�1IdeoaN4(PII� ?ti' �''j'e^'i
Sb.Latitude apd longitude in d
o� agile e�•ees/mimntes/seeonds or deeaaaI degceex
Lt7oagJss ) 22.Certi&rstioa:
3 G� z2�'.3v N ��' - 5d -
/2_23-z/
6. are the s• crmanent -or OTempor=T 1060 S4==ofCansea wcn
Ts(are) �()• Date
�.is this a f'gv.*ftf-M.1 by 0—a Me>�[s),.m t�J COMVU=da:a=MdmwVM
repairtoaaex4&gweM-- EYes or Mfo LU27 CO2C:0100orLUlCIC01CMWWrdCpvmnmroaSas&n&wdzbwaco
gy
Ij$dSSasgxtt; llaebmnii.eIIcm:rmaertarra+fora�m+maiesptamrhe�maoeofrhe alrhlsssmrdhasbm�FowldodmrhesrrIIo.mv
'nepob�€1l rmrmisu�onoranflJeb�ojtfarJarnc - .
23.Sit diagram or ad&doaal well detour
S.For GeoptoUMPT or Closed Loop C.Mthermal Welts having the same you may use the:back of this page to pmvide additional adl totem info
ea on,c*1GW--1is•needed.MclteTOTALNUMBERofwells (add'SeeOveeidRenfaftBox}YoumayalsoattachadditiQaelpagesif==".
dared:
24.SUBMITl'ALMiSMUMONS
9.Totalwell depthbelowlandsmface:
ForaadBplsvtlit deptlaif v>tr _g(o�00'm�d2�pp� (� submit thhGW-lwilhin30days'ofweIItompktioa per the fdbwbW.
10.Static water level below top of easing: 0 Z4a. For All Wells:(�) Original fo to Divisim of Weber RJsoruces (DWR).
.Yuntarleeottsobmrcc=ft';-�t-/ onP==iagU,*,1617 MC.Raleigh.NC27699-1619
M Borehole diameter. (, `r (m,) 24b.For hkedon Wen=COPY tD DWR.Undewormd inject C 2MI(NC)
hWdm,1636 MSC,Raleigh,NC 27699-1636 ..
C e Wec =bW,c blc6 method: 1 `t�Z h-'-•� "�' 24a For Water Sn and O Lot Geothermd ReWn Wells Copyto the
(J,q�.��.ale,�aeCtpRtl� _) Dp1V DEn- D '
OOM EVIInGmCGf2l hCelth CpaLimGIIt COn<dy
FOR WATER SUPPLY Wlrrr c ONLY: �{ 24d.For Water Wdh Prodachmover 1 QO GM.Copy LD.MW CC=A
13s.Yield(gpm) 2() Method of test: /'1 �`� P=M9 hnim,1611 MSC,RWei C 27695LI611
13b.DitihxBon type: I)f 1)A- Amount: D
FormGW1 NordiCMMr=D'quweacofFavaomnesstriQminy-Divi nofWae:rRaaaas Reviwd6.6.2018