GW1-2022-09100_Well Construction - GW1_20220926

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1.N"/•ell Contractor Information:
114.W%I IjR NEer
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15.OC-I'I•:k CAST (:\ (far m ,ells)O
multi-cased k 1 1NI.k lTl a) h,nble�
CC�S�G � ns,y II wyr L { �run\tuttNii'ili< route)-. /��I�ilnitl _--
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_ ( 16.1\Nl k CASING OR URIN( IE,r thermal closed-lo(p)
? \tell Construction I'erinil a: ° I ul l,t E'f"` —-- .. 14)
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-\tlulf�r tins,<eu,uul RCL„`.C•, 19.CaNI)/GRA\'GI.PACK Of.t rlicuble)
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I 1 lacer 20. )RILLING LOC(attach additional chcc is if neressnr,)
f,crahcnn,:;UIc,1nl!c(,i,hna R lltnl a rnit,l rl) urx en'(Itt\Ihcr Ir�pI;nn ua,C1 IZrncnl l ! _-- —..
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J.Ilalc\\rll(sl(unyrlt,tcd: Z. \\ell ID# J L G ,N�.r,lT[t I Zg 1 37 ft-
5a.\tell Location: A.
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5h.Lit fit lade and long itude in dV21-ces,nli out cs!seconds or decimal degrecs:
CerLlht rlion:
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7.Is this:r repair to an esislint„ell: Yes or ®\o „rn,!,I \! it il;( elan,,, s r aV ri un u I r r..........
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23,Silt,diagram ur additional%%cII details:
s.Vol.Geoprohe'0111 or Cloud-Loup Geothermal\\ells hn,In',';hr.tuns 1 nu nun it,,: the h,lch of till,pagQ'I„pim ulc addilional ,.\ell ulte del:l!h of ,,,•;I
c1alsu':!,uol:.r,1" 1" lM-I I'.nerd ii. hullcatc l(PI Al.\I MM R of t,clls con uucurm details Ylal mat J1,0 minch:Iddlw,n:ll pa,a:s ii nccc�s;n,
didled
SL13\ll"hf-\L I\'S'fRhC"flO\S
t.'lot II ncll depth behm land surface:
r, ,riJ.;•, IfLI 24a. hot all \1clk: Suhnu! lhix Iurri ,slthm �th d:1,.
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conurucu<al u,file lidluwln�..
I11.Static,+ahr Ic,cl helot, u)p of casin Dicisiun ol'Waier Resoul-CCR.Information PI-oel9sint!t'nil.
j Ihl7 Y7ail ticrsice('enttr.It:del h,\'('27699-I617
II.Borehole di:uuafcr: 'O lin.l
tab. For Inicclion \Yells: Ill oddilwf: nr.rndlni-, the tornu' file:Odic"of '-
.Ihmt:. ❑m, >uhmil rate cap, (?( Ihrn I-,ran ,s)Olin t,l de,> of r,anp!cuon yid k'cl:
12.Nell Constructionnulhod: 0�0�-sl9ef/• L. _
r7.0 auecr.n,etrr.cairk.dlre!,�„h.;I: I
./m�lnlru,m n�Ihr:fi:lhr„mg:
Uisision of\NaIvr Resources.I nderl;round injection('onU'ol Pr ;;ra ont.
hOR WATER SUPPLY\\"I;I.I.S I)\I.\ 1636 Mail Scrricc Cenfcr.Raleigh.\'C 27699-1636
13a.\Off("pill) \icthud of test:— 24c. For N aler Supph S Inicclion N ell%: In ;uhlluon ur sendlna the l(vm to
the .lddrrs,(eS) above. ;d.o 'uhm'In ,me cr,p, uh Ihlc lornt %%ilhill "I) dat',e nr
I31).Disinfection h'Pt" ;\atonal:_ conylletlon of%sell tonslrticnnn I(, Ile' Conn), hcahh dcp:utntrnl Of file c„un[%
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