GW1-2023-02824_Well Construction - GW1_20230420

,
•
. L.
We1l.ContraMorInformatio/n:•, • . „ . ' .
_Vn )/. truh�P •
hdlIJ/ r .
'WcUConhi ctarName 14.killidI�ZONEMOiv°Lis.��rs�.�t�;�w�r.gd?Ki p"' " rr.���ccr. :.•• ���
t O' T'wSt..�. nca n �hY•Z•1t•.'tf lY:S:'t 'a.�:Id 1
any_. . ,lw�y6a ft. 30 ,1 I . .
NC WellCoalraetarCealffaatioaNamber • ' •• •
' ft.•
f��// ^s 9`76+O1fNEEBSCA6ING AT
r0 5 J�V-C • FROM . TO: Weis ORIIlVER a IUcaAT MATERIAL,
r' 5
Comps:44a= • ft. DIAMETER ,: ti;.l>:. 6tATBRipy.
!a: .
•2.Well Constructionpermit#: • 103 'IGoIt• t!®1NG -fLee�'ateimat�loo•13x• G ::;;a;��,
Lfu a FRO,11 TO. !oto6,_,,:,;� TRIMNESS• •tz 3 et '
ppticahla i eamtntatlonperiattr(te.IIIC.Cavalry,Statg Ym4aae /. :: .
3.Well Use(elfecltweUase): . ' • n 6 '+,r ta• 32 ,E �'Id'
Water Supply ell: ▪ti7� Ito m. ';
ill Agticnitual • •• I_,• lit, ,. ii� ?t,'1""& '•3..a s8 a••e p .
�Maaidipa!IpubGc FROM f �4b. : ,�t SR �•s',:;rc
Al Cieothams! 0 ft. • fa. �� ':• (Nesting/Cooling �esIdentiatWaterSnPPl3►(�Ble) 'r ,
ill Industtial/Commeaciai ' �t�C��.� ft. fa: '
. ,n •
pCe+wsweotialWaDerSuPP1y(stand) s�iaxcaorir: t1lt' Tyr �' gt ," p�
Nort WaterSapp y Well: FRoac n Y
t;
7 !Z % u eaa�troa�
•
!1 • •naming
Injection ell:. Recovery ft. et
I1 •alferRecbaege • DGtoaitdwaterRemediation ft. • •
E '•
t79SADG ►VGcl.. Irv •} ticJ'•r i 1 ..I ;• •aferStorageandliecovery _Salinfy8ander . . . • .FROM TO r MAMMAL. Fn n l a METHOD: ' �StomitvaterDtalnage • •.'...
!et Expedmenta Teehnology . . 'DSabsideneaControl
1 Gegtiteuna!(Closed Loop) acer • ft.
A Geothenna!t:�tpnecooliagRetum) •Other , •IaiaunderS21Remarks FROM TTOev •f.,t.D O emra ': a ,, !`' • .es
O / rewmetc ,•� • Mtn
4.DateWel!(s)Compieted:p� �Zz.,W un d 1
• i' ft. rowf
Sa.'WellLoeation: • S`, ,
trrvrisinel •epfe< .,,,..• % Mai . ` ! yg ,• : i I'. t
FSd {OaraerNamnit" f -
. . . FaottkriDg igapplteable) • 6 • ft. , . :L • . . .
Coady
�' • u1,�R stet S"w'ta'?..'!L'•i -�nz„&,,.i,%*.3.7z1."".a..0 - 77}r@',Et 7.-:4ic I
• �ateetideattficalloallo.(P1tt). c�leiVCs S�i+O� '
Sb.Latkode and longitude Indegreeshnfauteslseco _,..:. '_dO( ?3ig3sr
22.CiQ • .N 7 Certification: '.
6 Is(aee)thewell(s)E1-ermanent • • •/�.�t.�.�� t`• rl
.or�TemPorarY • �oo.•..�a� • �• `-Z� .
Data
•7.Tstbivarcpafrtoaneuistin waif: 'ats++ ethtrjSrm1kmhywethatthewell ars
7.1 sI sas=garorrtl6t mutating
i ea ells t10Yes or ONor , Wilt ISfNOICO2C.0100erMAC�iO ��' 0►nzaurtle_nand In rersan ndmar
irm Gt[ennalloamrd=eaume nature vats coPYol mnrdharban ' 01d1iitl A'ellQotupurtiatt aadf6ata
.repatianda•62.tmarks t=aronthabaekeddsfomr. • • pr+arldtdto(Uarral(otrKer,
dialFaaa
8.F6rGeop:+obe/DPxorQose'd-L0a CeotbeariglWeQsbayagthgs�e You may og� o • "
co sta:don,onlyl GW-l•is needed:.IndicateTOTAL ERofwells1 • , . tnectiondetatls.Yon ���pram. QII� 'seamy. t
�, '` r �4y�4attecttaddtoaelpagrsifIIOgg{fir,
9.Totel well ttepttibetow land stttface: 3 as5� ' • 1t0t31yn7-reT,m rrrtrrmO1,fg. ',: • r I
FarAadtpptetrdlsft talpdepthr'Ifd l le•3C Vand2Qf00) . (ft)`'7�te., or' 1[ •Sabmit this•foul within 30 • :•
' coa9huctioaothefalWtving: �of conviction of well
10.Statiewaterlevelbelowtopofcaaing: 3:� ' :' � • '•
•(Ea'atar(atrdfsaboveearla&urs•'+" ( ) Division ofWaterReaotiicea,7nforwaHonpr6cessm U
I1.Yioreboled�ametere • �y� •• '.1617MatI&WeeCeater.RateigbiNC37039-16g17 .;•-, '
24b.Yor infection Welty: In'addltioa to sending this foria to•
12.Well construction method: s" ,p` •' cal xr%onstruction
also tto the one copy of gib•Soma widdn 30 d a� 24a,
(Le.augeroo aty.cabta.dt�tpa.+b.eta.) • •eonsttuottoatothefoIIowfagt • asp oFwmplWiori'oFare�( •
•
1r08`WAZ�RSFIPPLYWEI,ISp1�I,X _ Division.ofWat;erRetonrces,IInderground injection 9ontcolPr•
ograay
13a.Yleld(Rim) J • 1636MailSeeirlceCenter,RaistP.b,NC27699:iq'6,
.d Method°West: ' 7-
�c.Fm`Wa •Sunniv&Tnieetioa WeIIa• la eddidon to
13b.DIsbtCeetIon Type:�/ ark,' '•
the adds ess(es)above,also.submit one'copy incites ��to
Amount: Z_ •co py of health
form,ientwithfn the loon of_. mpletloa oftvell eo>£ahneNea to the ccim4yr he6lth of tttuy
•
• . . ' •*hareconst:natedc. co
FomiGW--! • Nad6Caro6aaD •
••
. 'apaonseatolypkonnienta1Qualliy-DIvbfoaioFWatertiesannzs: ' •
•
Uavbed22016
. j 1 �,