GW1-2022-01619_Well Construction - GW1_20220203

WELL CONSTRUCTION REca. For.F Use oaf:
L Well Con motor meormatiom �-
wenCoaeacaorit� •.i�.weTz.Ftzora�s... -,;. .: -
1 F+80M so :D*ZC3?J=0N
xc Wen coc-, R
n. CASING Sm�am1$-erred wi16 OE LiNBIR' .n.?:._•_.
�•�y�>yt NEme �� v EROM R Tn D]'ebAT� TOSS ..' 7w.•>•�ar.r-
is
2.We11Co=troCtE0nPera1t8: 0-7-3-to
Bona iv Diem zman� ase�rsr..•�„
UssaII app$mElt�aII a�aDaalenP I�LQC Cora+tY.�C Ymrmrg acJ -1^ R R .6 716' in. � tl,
3.Well U3e(check well use):
Water Supply Welt: 1127
'$CR$$t7.i.- +^ M1ta EY� `x !x'L�.;Jry�;4rV• .i ^�w ..n ,
13AVi=bzd FROM ft.
DIe2�ZD; UDrSEM - sfslzatuL
QMtmrespal/PtrbItc
OGe�(Heq.*/Cooimg Shy) Watts Supply(smgte) R ft. is
O UCommerciai D >I00 at er GP�y(�� .18 Gxavr�• :� v i:-^.�":-t_�tU :::
t".Fap~rwca�rrF�rsoD�wt�rotnrt Non-Wales Supply Well: � R R
M TO
DM�ing ORecovery
Injection Wcu; R R
QAga¢ferRecbatge QCaoundwaterRamedMon 1• R
13AqmferS=VimdR=very DSatia$yBaaia• '.;MSANID 13L'PACS'tf i••aJiv�;.c. '�.. . ...:t':=.�••.
OAqudzrTest Fa►> wri�eD
.DSMmrwaftrDtaiaage tz R
0RqmftenWTecbnd1oV . DSubside=Control R
QQeodganal(Closed Loop) OTracer =7A:DBILI.IId -IIADG atliet6i3ag"W, }
QGeoffie�sl(He�mpfCoolmgRetum) ❑0d=(aq�lamtmder#21 Ramada) FitOM R TO ILDI:SQi1PiION cab ytrVtaet - qc
4.Date Weg4)Completed: l—2Y-2 Z Well mJ#6 R R d
Ss.Well Lotafion: R R
FaCTdy1QWnerN4me FacgityMg faTH=ble) ffi i li
CAM—L.— - ('rA1t Ylu c,�' RP*skd R
( IImo{`QN=&r4p IL 8 --
I -
C Pmad MemificadnNo.(PRO
5b.Latitude and loaetade in d !
(�weIl field,one 1at/loagis epeeshmm�ies/seconds or decimal degrees:
22.Certification:
_36' IL` 5s " N 9d ' SZt �'"W
�_/ —3/—z z.
6:Wan)the well(s): nrl- anent ror QTempor=T / U 2-01 si�oamte ofC=fM&NeII� per,
7.Is this a _/ B1"'�tg�'f°�1�b1'�lYrlmrhe�(s),.or(.reJ connr®dLsaaom�noe,.d•G
repaa'toaneaslingwell:- ,axes or O1�To 15AN=02C.0100-fShcr-AC 02C.02W ffieff Cv=vzcff=Swx1MfVm2fd=acopy
ljrhCrisarg+alr�oadlaowTtreIIaooaar/cCcotbJ6rmmfmimiiagdabtrhermvasofm, of&Vsrc md/=baappwfdoimrheVedown=
rep&totdarir21renarf sacffonoran&ebaekoftfarfmM 23,Sibe diagrAin,ofaddrQoaal wen detaIIs:
S.For GeoptobemPT or Closed Loop Geothermal Welts having the same You may use the ba dr of this page to provide additional adl conshuctien info
no on,only 1 GW 1 M-=ded.?n ckm TOTAL NUbSEL ofwea (add'sec;Ovee fn Remmft Boxj You may also and additional pages if necemy.
dared
24.SQBMITTAL INSTRIICTIONS "
9.Total well de below landsarfacer Ta>V
Fosradr�pfs,.adr amdeprlarjown( e-g@200'artd2®I00) (� Submit this GW-Iwithm34 days of well completion per tlufalinwhig:
10.Static water level wow top of easng: y-(] (ft) 24a.For All Wells: Original 8on=r to Division of Water Resomees (DWR).
1f+�laodisa6ourcamin$'Kse-+-- Iaft3n2ffoaProcessin9Uhk l6I7MSC.Raleigh,NC27699-1617
11.Borehole diameter: I a (m,) 24b.For Inaction WeIlx Copy to DWR,Undemmtmd Nectian Caeud qM
1— PmFina,1636 MSq Raleigh,NC 27699-1636
12.Weli contraction method: �O d' —
C-G��.�dinxtyw%�) "`1 ry 24c.For Water Supply and Oven-Loop Geothermal Retina Welic Capyto the
:. ootmty envapam apartment eo=dy iiuedd
FOR WATER SU MMY WELLS ONLY:
24d.For Water Wells roducim over IO DO GPD:COW TD DWRr C=A
13a.Yield(gp]4 ` Method of test: rY' Permit Pmgram,1611 MSC.,Rslei C 9 ail l�
13b.DLfWftefioa type:_L:1 s !4 Amount
F=GW1 NordrCamliaaDepact =ofB.*om eaalQuality-DivisionofW=rResoucoes Revised61r2018