GW1-2022-07344_Well Construction - GW1_20220808

Well Co are FROM TO DESCRIPTION
ft $ l
olI A ft ft-
NC Well Contactor Certification Numbet
Li:OD2 •CASlNG,(focmnlii=eafedw0s)OR
C�a
Morgan Well& Pump, Inc. : FROM To DTe srrr u Tr�clvFss MATERIAL
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Company Name +1 ft ft 6115/ i sdr11
I 16 II��TER CASING O&•TUBING: eotlierrmal rto'sbd4od"?.`:."` :"'-
2.Well Construction Permit#: FROM TO DTANJE! THICKNESS I MATERIAL'
List all applicable well construction permits'(e.UIC,Countv,State,Ym iance,etc), ft ft P in.
3.Well Use(check well use): ft ft. bL
Water Supply wen: I7."SCREII�T',_�.:'•t=- .`::;-•._•_• _ :;.;�:.• �w �t`,:•-;:':=:.. r.:.�::•.:.•:::
FROM TO' •.DIAMETER SLOT SIZE I.-THICKNESS MATERIAL,.
Aglieultural bMnnicipa]/Public ft ft
i Geothermal(Heating/Cooling Supply) Dt Residential Water Supply(single) ft ft in
1 badustn Commercial PD Residential Water Supply(shared) r •= -.:>--.:. :tom:"' :- -r:'.:: =:`.
::IS-GROUT..'-
-_ ::.>•:... . ._ - . .
i hli. ation FROM I TO '.•MATERIAL �. EN21& ENyNPMETHOD&3MOIINT
Non-Water Supply Well: D ft 20 ft bmtonite. pond
Monitoring DRecovrry ft ft
Injection.W-eII: ft ft
Aquifer Recharge K3 Groundwater Remediation
.79:SAND/GRAVEL'PACK if
Aquifer Storage and Recovery DSalinity Bawer FROM TO I MATERIAL MaLACEtdENTMETHOD
Aquifer Test DStormwater Drainage fL fL
Experimental Technology OSubsidence Control ft ft
i Geothermal(Closed Loop) r3Tracar :2D.DRiLLSNGS OG'(attactimidditional sheets�f fieces's 7' ='`=s :' -:t:
(H �/ g ) (explain under#21 Remarks) FROM TO DESCRIPTION(valor,hardness,soil/rock type, size,etc)
r Geothermal eating Coolie Return J Other Oft ft
SO 40-6
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4.Date We1l(s)Completed:q-J5 Well ID# ft ft
5a Well Location:
ft ft
n ft
&a ,1
Facility/Owner Name Facility]D#(tiapplicable) ft ft-223� Car� vr Ls NLZ fL ft 20Z2
PhysiealAddress,City,and Zip ft ft ltTi]Aiea.lt^^.0 ^^c
County ParcelIdenlificati=No.(PIN)
5b.Latitude and longgitade in deb ees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 2 cation:
S45 Awl -N 10 1631 W � a
6.Is(are)the well(s) Permanent or �li Temporary Signs T
ed Well Contractor Date
B animm,I I:o ebv certify that the wen(s)was(were)constructed in accordance
7.Is this a repair to an existin;we1L• Yes or �No is0a 75AC.0100 or 15A NCAC 02C,o2oo weII Consi uctian Standmds and that a
Ifrlvr is a repair fill out known well construction idformadon and explain the natty e of the copy ofthis record has been provided to the well owner.
repair under 421 remarks section or on the back ofihis form-
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.For Geo , o only
I G or s needed.
I Geothermal Wells having the same construction details. You may also attach additional pages if necessary.
construction,only 1 GW-1 is needed Indicate TOTALNUMBER-ofweIls
drilled: I' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: ao (ft) 24a. For All Wells: Submit this folm within 30 days of completion of well
For m ldple wells list all depths ffdf,�erent(example-3@,200'and 2@100) construction to the following.
10.Static water level below top of casing: (ft-) Division of Water Resources,'Information Processing Unit,
Ifwater level is above casino use"+" 1617 Mail Service Center,Raleigh,NC 2 7699-1 61 7
II.Borehole diameter: 6 (in.) f 24b.For Injection Wells: In addition to sending the form to the address in 24a
12.Well construction metho d r o �L1 above,also submit one copy of this form within 30 days of completion of well
construction to the following:
(Le.auger,rotary,cable,directpusb,eta)
Division of Water Resources,Underground Injection Control Program,
L13b.Disinfectlon
TER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 2 7699-1 63 6
(g in) Method of test: 21r pressure 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) 'above, also submit onel'copy of this form within 30 days of
typ Amount: 2.7- ;wt completion of well construction to the county health department of the county
where constructed
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised2 22 2016
I