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Home My WebLink AboutGW1--03648_Well Construction - GW1_20230526 c) WELL CONS1..RUCTION RECORD(GW-1) For Internal Use Only. • I.Well Contractor Information: I • e�{r t.\I T • Si .\1�,e,+, �s 0ro 14.WATEt:ZONES Well CoatractorName FROM DESC RIPTION CRIFI1ON a g as A 1 % ft: {,01- 3 P V\ _, NC Well Contractor CertifieationNumber a�� I IA y, cy Well {''� Inc. 15.OYTTER CASING(formulti-cased wefts)ORLINE•ROfa�eahle) • - Ste-p tensor its V Veil telling, I FROM . TO - . DMMETER THI('�E. MATERIAL. Q IL SS it. . .1/i, in. SW\at V C Company Name - 16.INNER CASING.ORTUBING(geothermal dosed-loop) • 2.Well Construction Permit#: A/ A It r t p,i-1 c r FROM TO DIAMETER. THICKNESS MATERIAL . List all applicableivell constrnaffnnpermits Le.(JIG Camay.State. armn_r etc) N/A f. ft. m. 3.Well Use(check well use): . ft. ft. in. I Water Su Well 17-SCREEN . . ..-r -- • - - Pply FROM TO DIAMETER sLOrsi7.£'. THIC IMESS MATERIAL 9Agricultural OhlunicipallPublc A//A ft' ft. in. Geothermal(Heating/CoolingSupply) DResidential Water Supply(single) rt. rt. is Industrial/Commercial tRtsidential Water Su I sham Supply(shared) i8.GROUT .-. ,Irrigation Frtth'I I TO 1 m- '!M. EnIPLACFMERTMETHOD&AMMOUNT Non-litater Supply Welt: 4 ft. ao � �Q_/.`f l/lif'_. %iA 1' --o 11, hots J- Monitoring �Rccovery I ft. - ft; .C.I1 t r 'Injection Well: v l i); ft. Aquifer Recharge DGroundwaterReaer �zm F I 19_ ANDIGR& PAG (i applicable) (3 AquiferStorage and Recovery a1Sahmity Barrier .:nojt r,. _TO t MATERIAL E'ti tMACFxttEtv'T METHOD Aquifer Test stormwaterDrainage �l/1� IL Fxpeome:ntaITechnology 3Subsid .Cannel • . Geothermal(Closed Loop) QiTtacar 1 2t1.DR€s.1.INGLOG(attach addititinnI sheetaifnecessnry) = - -- ether( lainuader lRP*ac;. I elt09i .. TO DES(RIP.TION(miar.b:rdness.=Wroth.t�wi�iasizeetc.) DGeothermai(Heating/Cooling Return) ecp ). . . . .. . I . . 4_Date Well(s)Completed:'Sr3- •�"-A. Well Il / rt. ;l o .._i, I - �'ms• (�.. •'C Ip,�J Sa.Well Location: Ii S LSro WA:. ;�t71 1►t(, -r01/ '• ' I� son 'St: �d.l l�Q1C� L!`C 50 34 J o'e.k - Facility/OwnerName . FacilityII?R(Rauch-rt) r"''7"ice' G:" r -" .i L. 31 a -. Sorg S+. F io:r.kl lr.4c r\ .Z Set.-5 • : Physical Address,City amlT.zP �- MAY 2•ii 2.1123 V ro.r.1( 2L REMARTCR:: . rn :. • County Parcel Identin�anNo_(PLI) '... •In».,rt,_s t^W +�f?:.:v.P�:f^r Ln� Sb.Latitude and longitude in degreeslminutesJseconds order;rml degrees: . .. (if well field,one tat/long is sufficient) -22.Certification: pc.° , {qsl N -1%° a1' 4" W 3-a3 Si F �t Weft Contractor Date .6. s(are)tleceII(s "Pe-manent or T por2ry - • .B),stning this form.I bueby ce_r1W that the a-WV bads(zzrete)consi acted in accordance 7.is this a repair to an PTieingWall: Dyes or VNElo with I14'11 AC 02 011Fl1 ar IBA IICAC O2C.D2014 Well Construction Standards-and that a If this is a repair,fdl out known well construction information and explain the nature ofthe aFP ofthirrecord has been provided to thewel/owner. repair under#21remarkssectionoron the back ofthis-farm -23.Site diagram.a ndslitineat Welltlern5is: ' - 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 1 GW-1 is needed_ Indicate TOTAL NUMBER of wells construction details-.You may also attach additional pages ifnecessary. drilled: . SUBMIT TAL INSTRUCTIONS 4 9.TotaI well depth helowland surface: 2 ` EIL) 24a.For All.Wells: :Submit this form within 30 ilay of,completion of well For multiple walls Err all depths ifdif[crent(example73QZ007and 2 e(I00) • construction to the followin 10.Static water level below top of casing: 3C) (ms) Division of Water Resources;Information Processing Unit, Ifuater level is aboi a casing.use-+" 1617 Mai/Service Center,Raleigh,NC.27699-1617 11-Borehole diameter:. ' (in) • 24b.For Infection Welts: In addition to sending the form to the address in 24a Q Q above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: ! 'I r 1\Clt(T l'y - construction to the following_ - - (ie:.auee,rotary,cable.ditectpusb,etc.) Division of Water Resources,Underground Injection Control Prograur, FOR WA!kat SUPPLY 7WELLS ONLY: -. (�� 1636 Mail Service Center,Raleigh,NC 27699-1636 Method of t� V�N 5 cJ 2Ac•For Water Suttnly&ilisaectiaa Wells: In addition to sending the form to 13a.Yield(•pm) the addle ss(es) above, also submit one coF1:of this famm within 30 days of 13b.Disinfection type: Ii t I-I Amount I D-• completion of vseli construction to the county health department of the county