GW1-2022-09276_Well Construction - GW1_20221003

Well oZ_traztorr FROM 0
Yame 64& & To
ft
zm- - DESCRIPzlOty
A M ft.
NC Well Contractor Celtification Number is::: a-- . . ff.,- U hl'y
:C24 R 12tm
1 15;OUTER-4ASMG !R CL ai
Morgan Well &Pump, Inc. FROM I TO. DTeMArWR THICE2im MATERIAL
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company Name +1 ft ft r,Ila/ sd I pvc
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IrD�UMR Ce1SING
2.Well Consfrmetion:Permit#:
FROM TO DIAMETER f TBICIOMS MXrERIAL"
LA
Lie afl applicable wa construction jomnirs'X a LUC,Cowgy,&atp,7x*mce,aic.)- ft. ft. In.
L ft .
3.Well Use(check wall use): f In
I I F
I7__SCREFN*,_­'.
Water Supply Well:
FROM TO D SLOT SIZE TBTCKMS
Agricultural
gricultural 13MunlcipBl/Public ft ft
the
Geothermal(Heating/CoOling Supply) DResidential Water Supply(single) fT. in.
1 7 ft_I a -Ca _R
esidential esid-fial Water Supply(shared)
b j-�tiom I FROM I TO M=OD&AM011111:
Non-Water Supply Well: 0 ft 20 fL bent6b. poured
DManitoring oRecovery IL ft
Jnjection.Recharge Groundwater Remediafion It I ft
R1!.'19:&9VD/GRAVXL'?A:CX 6f kp�lllchb a
A=,Storage and Recovery DSalinityBairier FROM TO I MATERIAL MM OD
Aquifer Test j3StomrwaterDrai:uage
Aquifer
Experimental Technology r3Subsidence Control ft. ft
(Tracer
Geothermal(Closed Loop) 1:28.'DR=G.L0
E :4 1 FROM TO DESCRIPTION(color,hardness,soiltrock type� SIV,em
JGeothermmal(Heating/Cooling Reh-1 lain under#21 Remarks) ft.
t
4.Date Well(s)Completed Well ID# 145 f
adLocation-4��z
ell ft ft
ft.
—1 ft.
FacilitylownerName Facility ID#(if applicable) ft. fL
3c) t6-�C'k IZA mk- U(M
Pkical Address,Ciiy,and Zip ft OCT C) 207.7
County Parcelld— cati—No.(Pl]q)
5b.Latitude and longitade.in degrees/minutes/seconds or decimal degrees:
(rfwall field,one lablong is sufficient) 2 cation
go N -W
6.Is(are)the well(s)*Permanent or r3Teraporary Sigma f 1,3.eld Well contractor Datb to
-eby wt#- that the wells)was(were)constructed in accordance
is fib" I h,7 y
0 Fpea Constr�on&=dardr and aw a
7.Is this a repair to an existingwell;- []Yes or *NO vilb 7.i4 C 02�.0100 or 15.4 ATCAC 02C-.02,0
Ifthis is a repair,fiU out known well conshuction information and explain the nature of the copy ofthii record has been provided io the ivell orw7ler.
repair under 421 remarks section or on the bark Dft&s-form • 23.Site diagram or additional well details:,
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same 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 ofwtlls construction details. You may also attach additional panes ifnecessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land (ft) 24a.For All Wells: Submit this form within 30 dayt of completion of well
For multz:ple'wells Asy all depths if different(example-3@200'and 2@100') construction to the following.
10.Static water level below top of cuing: (ft.) Division of Water Resources,Information Processing Unit,
Y j Water level is above casb7'use 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 24b.For Injection Welli: 12 addition to sending the fbim to the address in 24a
above, also submit one copy of this form-within 30 days of completion of well
12.Well construction method: construction to the following.
(I.e,auger,rota ,cable,directpusk atc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY Y�=ONLY. 1636 Mail Service Center,Raleigh,NC 27699-1636
132.Yield(gpm) Dw • Method of test: all-pressure 24c.For Water Suppiy&Injection Wells-''In addition to sending the form to
the address(es) 'above, also submit one copy Of this form within 30 days of
13b.Disinfection fyp&CrjA-6* Amount. A2.- completion Of Well construction to the count i y health department of the county
where constructed_
Form GW-1 North Carolina Department ofEnvirommemtal Quality-Division of Water Resources Revised 2222016