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GW1-2021-02308_Well Construction - GW1_20210722
Low WELL CONSTRUCTION RECORD(GW 11 For btemal Use Only. 1.Weil Contractor Eutbrmallow J GaN-Thompson tveuCoanaetortVame ram TO.. DBSCB)FRION 4418 A & & \ VC We1lConaonhnrCmdamtionNi®bar • I6:011TBR. aYcttiernedwmt3s LnVSR� .."IteaWe�`� .•.•.-... :... Aqua Dnll, Inc. . ant peyN © t" I q j ft. C. W. \ �1 ,0 y 16I1RCAsnvGOR.74rBn�IcId WMAI 2.Well Construction Permit#: To J INZAAKIRTIM fwaUopplrmbla,mlloanstracttonp Srontvaromere,) ft. ` fL 3.Well Use(ehwk well user „ ' 10. 1M _ .. WatrxSnppiy WdL• ... : .::.. :. :. .. . .:... ..:. ..... ... �:. ..> :. 7LI TO DD1bIE1Y3R 6LOTAecultwal n0itapel/Pub1tC IResidMiai Water Supply(single) f` ter. IndustriallCommercial 0Itesidential Water•Supply(steered) 18.GROUT :. ..:; .. Iri lion on AIATERMss>p >he��.tnromsr Non-Water Supply Well:, t R Monitoring RecO R ft. action. . uifer f�II)G RA I►9 �Gm Remmdiatioa FR SA 19. PBLPACg Aquifer Storage and Recovery Sal' Hamer Aquifer Test 0StorrowaterDrainage f ft Experimental Technology 13Subsidenoe Control ft. it; Geothermal(Closed Loop) 13Tmtxr 20.DB17.LING Lila attedt addtdoaat abeets tf Gemtltermai(Heating/Cooling Ream) -Other( lain under#21 Iternmlm sltonr TO Iffourdleabbi fa 20& 4.Date Well(s)Comple :��I Well MM Q 5n.Well Locadom -? R q6ft Fao,0100. N. Facility IDli(ifopplitxblo) t<T.. rr� t-io •�felrl� 11 P(�r(� ittt 1 ft [,. . l�y¢[�`cntAddmcc.C�1y. drip ft •1L e.� �1 Aln z1.RBMAR[ffi County Pmeel Identification No.(PIN) 56.Latitude and lothgitnda to ttegm'ees/mtnntes/seconds or decimal degrees: e, � �r rfaell Said,one Moog is suffident) 22.Certlitcattow ���r (�� o 09' N�U° � \.��qco W 6.Is(am)the weu(sj6Permauent or 13Te6porm si efC Wen Contractor Date 7.Is this a �'stgnhrg jb I hereby eerr&dmr the udt(s)I=(mery aonsanded to amordanee repair to an existing wa: Yes or [dNo with ISA NCAC 02C.0I00 or ISA NCACO2C.02a0 WdI Cmr&won S7w*n$and thpra ((Ihie tratepah;Jlll eutkrohtrr�refl tammnadonlnjomwrknarrd esplaln7heno0me 9f►he eopyojd s recardharbeea pvWdedm dm tadlmrnen ropofrrmdarA?I reomrlieshredon oron rhebaokojthbrjomr 23.Site diagram or additional well detans: 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the some You may use the back of this page to provide additional well site details or well construction.only I.GW 1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional page ifnecessary. . drilled CC SUBMITTAL 1NSTRUCITONS 9 Total well depth below land surface: �J (ft:) 24L For All Wails: Submit this forma within 30 days of completion of wen Rornuftle�retls![dolldepOsijd�e�rr(esamT/e-3(a�2a��D•,,.ar��rd2(a�100� constriction to the following: iR Static waterlevel below top of casing: J (ft) Divlston of Water Resources,information Processing Unit. IjmvterlerrJlrabareassln&ass- 1617 Mail Service Centel, Raleigh,NC 27699-1617 1L Borehole diameter._ (im.) 24b.For Iniectiou Weil_: In addition to sending the form to the address in 24a above,also submit one copy of this foim within 30 days of completion of well 12.Well construction method: ABC construction to the following: C+m�.�74 ea61e,d'aeotp>csh,etc) Dtviston of Water Resources,Undergrotmd Injection Control Program, FOR WATER SUPPLY WELLS ONLY 1636 Mail Service Centai,Raleigh,NC 27699-106 •13a.Yield(gpm) I M Method of best: _� Me.For Water SuRuly&Infection Wells: In addition to.sending the form to � .�� the address(as)above also submit one copy of this lbrm within 30 days of .13b.Disiniteetion type: AMA`A� g l �:o Amonot: 613& completion of wen construction to the°county health department of the county where constructed. Form GW I North oraft Depa mint ofSawronmeatw Qua!w-mrision of Wert.Resotacs i Revlred 2,22�016 j