GW1-2022-04909_Well Construction - GW1_20220525

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• WELL C iNSTRIIC12 - . • .
For.lotemal Use Only:
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2.Well ConstruettonPenoitso mamma =camas manzarer.
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3.Well Use(e.heek well use): •
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Waterupply elk • ./17. CR3ilV i.••.-V.r.1-'!agererc' er„.--W.tta•::•?..-.1.,:•:t:•,..,121k,'a411W-v0i*te..-..•
PROM •ro • mu = scar MAMMAL
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Modustriel/Commeisial
. - Water SuPPI7(thared) • -Ia.:Amour I., -• • •%.••••••:."4.:,:::::".•.;-$5,-.1:...-r- ':.".•4?:'',":-Pe.:.-*•t•s'-;;:-•: •
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• t!r... ClWells>100,000 GPD • 11=1-AmMEElimmirs'iiicirAr.
Non-Water SapplyWeII:
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.. ClErperhnental Tecbnology . C1Subsidence Control f. . f t. •
Clialcotheanal(Closed Loop) • =racer ,-:20:3fitrLTING•LOG 13Geotherma1 grerting/CoolingRetam) OM=(oplainunder#21 Remarks) 3252°24 I° DIsc17.n°"°13411'd2aLslaigat*".521"r'eft3
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5- 2-7.-4.Date Well®Completed: 41(- Well ID O • it ft
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312 ' Gi • ( "- N t gt no 1 23 ' W ' /193,64.01.4-0- d*re....---.0 • .
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6:Is(are)the well(s):4 ent rerman •-or 1"/Te.mporary
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7.Ts this a repair to an exisdng welt.- aYes or it, ISA MAC 0C:0100 or 154.17CAC 02C-0200 Ira ConinfetiatStanalarlsecalthataavy
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• 23.Site azranz.or adational well details:
You may medic back of this page to proVide additional wall constructka' :info
8.For GeoprobvJDPT or Closed-Logi,Geothermal Wells bavingtbe same -
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construction,anly 1 GW-1 is-nailed.Indielte TOTAL NUMBER ofwells (addfSee Over'ni" Ramads" Box)."Ebumayalso attach adchttoral gam grecessary.
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•24.SDBMITTAL7NSERUCEIONS •
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9.Total well depth belowland surface: .11-2'6 •
. , Submit this GW-1 width:30 days of well completion per the id/owing:
Forvallepkwar lir tacker fcEffierens Orazigic-3®200'!:oni2W017)
10.Stofic water level below top of easinv • RO - ,,, 24a.For All Wan 9rigtos' 1 form to Division of Water Resources(DWR),
vw InfannationProcetsiog Unit,161714SC,Raleigh,NC27699.1617
.rwararlavifsaSom casts.pse••+i-i
1L Borehole chameter: .L ne _cm.) • 24b.Poi-Infection Wells OW to DWR,1".6deolummel Neetian Control(117C)
Progtam,1636 MSC,Raleigh,NC 27699-1636 ..
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12.Well construction method: f R obi Alm,- 24c-For Water SuWv and Oven-Loon Geothermal Reim Welk Copyto the •
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(i.e.=get nitazy,cable,asap*,etc.)
''... county environm=health department ofthe county vihere mstalled
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.. FOR WATER SUPPLY WELLS ONLY: " 34d.For Water Wprodn' over 100,000 GPD:Copy to.DWR,CCPCETA
PermitProgmm,1 11 MSC, C 1 11
1.32.Yield(gpm) • . I 5 •Method of test Atel,----• • Italei
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1311 DIsinfec6on typc I•4.1-I I Amount I 2--
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Fox=GW-1' North CarormaDepenmeat ofFnvizonmental Quality-DMsion ofWaterResetates1
• Revised 6-6-2018
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