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HomeMy WebLinkAboutGW1-2022-04139_Well Construction - GW1_20220425 WELL eON�T1tU UON In or Use Oily: �- 1-WeII CoMaetor Information - • l��r,ea A WeltCoo®cy=N� ' . TO pox 3. 5 3 5 boo R' 7s4) s NcwaLCbnbzctOrC NcMb= R $ 3� e^/ =15 OIlIF3CA.S0ITG fiQmal4, e��ieIIs onL7Et' FROM ip D � $ 1� u�•rr�r•r 2.wdlCozestr oaPeratit P10,WL..0,O r�sn�r�oxz'tztmv IaII appFte�ablexII nPrrarlts Ra it{C Corday,SnmS YmrmrcK TO ueJ R R is ffismuel. 3 WeHMe(cheekWeH $ R m. waterSappl7WeII: 7$L�$ a. .{�� �;�e;� Ya CM�mictd/Public F"M TO D ' Geothemral(H-O*Coo ssors� - Msil[t7AL• lmg S �Y) CReadeabal WakrSnpply(sm81e) � OIOdustLjs/CS rmr,n.I pResideatisl Water ( R ILC03 ( � NIoa-Witrr S WeII: CWells>I00 000 GPD .IBGM TO Ro�c :. _ :r'� A °_N#" _:• ; �P1Y R 3 R Tw' a cn aoZron&,�ouxr Cms E' F103Aqaff= tion WeII: [7Racovery R R 13GmundwakrRemedMcx,,St�7vMdR�y� OSdh;ftyBaaier I9 S91�ID/GItA�LitzrTest .[JStomzwaterDrai�ge. $ TosM�w�tr� OB:p�Technology ❑SuEddeoceConiml $ g al(Closed IA") ClTtacer ZOrDBILLII�IGIAi: Cd�egfC'.00lmSReumi) ❑OdI�(exPlamimdrr#21Rs) FSOM Tonasoannol $ fL 4.Date Wdl(s)Completed: !"-?-ZZ Well Mg R fL �- SR.WenLodadon: - R R f $ Faa7ity/OwmrN�e FyIDOffsppTimSk) R 12it%-Air • dfF R � _� ' r� ��'!4��� ' Pf8sralAddssII;City,an34 C h+t w K R J 3 62 - • P-:6111e oaNa MN) SL Utitgde and long tade in degremlImmates/seconds or d,,Fmd degmn: "v ' C.Ewdificld eneWongnsaffi�) ' 22.Certification: 6.B(are)the well(s): Clvenoanent or OTemponrY Cj s Sig�nae of e]1 �, 7.Isthisa '� �8l�m.Ibt)nsrfac (sJirar(SnieJc°mor�sdmaczsvaimonrfiJi repait tO aII ea7tiltgwdb— CLYes. or o 156NCRC 02C:OIOO arLU=CO1.C-0200 3YeZ tCM3in &=:b*ar iAwa m IfaTdsSasrp�r,�1lloabmwreirdlemnararstar6rarmr'somLe:^-_�rzzri-sci=.�a:-, ofzFSrrTlxzS�r �ide:wSie� owna_ py repofrrordrv�2lraamJssaetronoronfhebeekofrlasf - Mr. 23.Site diagram or:d&gonad wen deftI 8.For GeoptobrJDPT or Closed-Loop Geothermal WeIIs havmgtbe same You may ase the back ofthis page to pro4ide add$ional adl infix boa,only 1 GW-1 is needed.3ndiedte 1m'AI,NUb lggt ofweIIs (add'See Ovet io Remarks Box). may also atharhadditioasl pagLs if y. duIled 24 SUBMMAL.INSTRUMONS 9.Totalwda depth belowLndsarf9ce: 72, 6 For aarltlplsi►z&Nir&ad4prlaij (—p..3@200'�92�M SbbIthb(;W-1 within 30daysof wen completion per thefouowiw 10.Static water Ievd below top of easaap: .�y (�) 24a.For All�VVeIIs: OriS ��to Divig on of Water Rasouiees (DWRJ I}',waaslendirabovsaocdr�ggse�+-. biouPmc�SUnit;16I7M5C, `/ Raleigh,NC27699.1617 ].I.Borehole diameter. l b fin.) 24b.Foi Iniecti°n WdL.Copy Z DWR,Undewoimd bjecdon Camlml qM Pro$ram,1636 MSq RaleiANC 27699-1636 It Welt eonstraction method: 04 1 CLe-Agesa�roh ,OMCi dneotgm3.ct..) 24e.For Water and Open Loop Geothermal Rdma Wdis Capyio the ''. . =mty ea mnmeaiat health depmtmeat c=lty lea FOR WATER SIIPPIrY WETLS ONLY: 24d For Water Wd b do' over I GPD:Copy W.DWR,�p(r(JA 13a.Yield(EPA Z Method oftesr Petmrtm,1 lI MSCy Raleig C 1 11... 131:Dion type: Amok__P 09 `✓ Faun GW 1' Mar&Carolina ofFmvno.oral Q°ality-Division of WaterResoraoes Ravbad 6-&2018