GW1-2022-01762_Well Construction - GW1_20220215

NULL CONS MUCTION REC_a (.-G�V Il For 7n�snai Use Oa)y:
L Wen Contractor Information: -
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W,z Coaa�Naaw .
FROM Ta ,DFSBSIION• .. `
3s3 s RECEIVED 100t, 20D tz
fL $
NC Wen Comtmetor C•a =16=24 tuber
FEB 15 202Z MO U ERCASDIG -MeO$Iu� .h r.
fi -!�..i•. FROM To Dreb� T��yg MA•�rAy
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2.Well CamltrctioaPmit //ltt+ 11i IPII�lBR'GfSlPIGORTVH1rIG dim( v >•• ,r._•
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3.Well Use(Check Wen user
Water S.>>.>.��ppl WeII: i?_�>, .
�•�yx�.^.�i.'.':.'�:FV v.7 �y •.r i:'
ClAgiculuiral c tal/Pablk FROM TO r: DldMi� SiATS)ZE: ~71 X&TERIAL
(He - dermal 8 8 7n.
OGeothemral e(rag/Cooliag S ,y) Water SWPly(single)
.0Yrr mUCommertdai ❑vesidentfal Water Supnlf(sbamd)yrriatiorl
l�ioa-WatrsSaPpliWeil: OWeM>100,OMGPD FROM TO Sri ;•;-' � .►c r'rr> oa �►�[omrr
fv ea k .,0
OMd�imr� ORecovay � $ .p
Injection well: f a Ii a
OAq�faRec ge CcroundwaterRemediation. $ .
OA4mfaSt=w2odF=ovM7 OSalkay82aier :79 S9NID/Q2AY3LPA K��G3=.;' " i�r••�arc� ':_-=a.
FROM TO MATpR>AL =11tPFdCII,@1r110�9D
DAgaW=Test OSMmrw31erDminW � R
MExpedmanwTechndogy ❑Subsidence Control $ g
OfleothetmaI(Closed loop) ❑Tradxr =2aDR11d.II�IG•LOfr atlie6i3disiamLsTteEltif �"•� '>: �.:'.
DOW&eaadMeawgCooling4caaa) OOther(explamtmder#21Remada) FROM TO Dia�nOxa,to aiv�,et
& ti
4.Date WeII(s)Completed: Z-`I' Z Z WeII IM 4t i
Sa.Wen LoCaSon: . fL fL
ter;
FaeditY/Owalec/N�n®]e� A Facey IDli(ifgPHC le) $ : !i
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5b.IA11turle and longitude in degreesl nTmutes(seconds or decimal degrees:
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w ca oa:
3 L • 'Z�'� 2 ' vo 6 2 - `� .• ZZ
6 Is(are)the wen(s): eraument ror OTemporary / D 7 O J Signature ofCertiSed:Wen Dose
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23.Site diagram or additional wen details:
S.For GwP;obe/DPT or Closed-Loop Geothamal Wells bavingtbc same You may ase Ste back of this page to pm6ide additional well construc6m info
dOmMichOn,catty 1 GW 1 is needed.Iadicift MIAL NIIlvOM ofwena (add'See over'in Rem Box).You may also attach additional pages Xwoeas y
drrIled;
24.SUBMITTAL IN MUCTIONS
9.Totalwall depth below Iand surface: 226
ForradupkweArZaaff,4 e4 (=; e_g@200-. d2@100) (� 'Submit thUGW-lwithin30 days ofwen completion per the following:
10-Static water Level below top of analog:_ y 0 fc 24a. For An Wells: Origizml Toms to Divisicrs of Water Resources (DWR),
If7wrerleoottrabe,+eamti7�fae"?- ( ) bgmnIIonPmccmimgUni416l7N15C>Raleigb,NC27699-1617
1L Borehole diameter•. (m,) 24b.For Injection Wells:Copy to DWR,Underground lnjeeti6a Control(I q
hvF,nn,1636 MSC,Raleigh,NC 27699-1636 ..
-;gg rOt�rl,cable.ditectpmb,ate.)
12. construction method: is18 - N
(Le.no 24c.For water SnDDI9 andOpCa-LOop.GeothermalReturnWclTsC,Wtothe
:. county environmental apartment ofthe county wn=tamed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells produft over L 000 GM.Copy 10 D%R CCPCUJA
Uk.Yield(gpm) 5 Method oftest: 5XI,
PaM PM98m,1611 MSC,Ralei C 1 11
13b.DisinSeedoa type: 'Y Amount: d '�
pour GW-1'
NuathCe<olioaDepaz=eatofFavaonmrntalQoalitj.-DiviaoaofWater R=vised6b-2018