GW1--03721_Well Construction - GW1_20230602

WELL CONSTRUCTION RECO r�v_�. . For blemalUse 093-r I i
L Well Con .Information: s
14 WATERZONES "-
Well Coauactor FROM TO DESCaII'1ION
9T 0Oft• OOP
ft m
NC ollContracwrcadacadoaN
15.OUTMRCASIIVG farmulfi-casedwdb ORJjrM tfa Noble
FROM TO DYAMETER I TIDC[Q�SS MATEEtrAL
CompaayName ft ft
7�� 26.XI MR CASING ORTUBING eotbermat elofed-lao
2.Well Construction Permit#:- lJ / FROM I TO IDIA11fErEg T�QgL
Lid aff apph-blewel[wnsozwionpesa lr ge WC.Cmmry,Slats;,WMC4 fjr) 4 ft 7
3.Well Use(checkwelluse): ft ft in
Water Supply We1L• 47.SCRMMN
OAgricultural 0 FROM TO DL1MbTIIt Qr O Q ZE T�CRNESS MATERIAL
NltmicipaUPublrc ft ft
0 Geothermal(Heating/Cooling,Supply) &dential Water Supply(single)
ft ft in.'
Oladustrial/Commercial dential'WaW Supply(shared)
01nigatiop
Non-WaterSnppl yWelL• 18.GROUT
OWeIIs>100 000 GPD FROM TO MATERLLL EMPLAC.EMufrMkMOD&AMOUNT
O ft ft �,�,
OMonitoring CRecovery ft
Injection Well: O Y F•j 3 t-•d ,i,Jl
OAquiferRecharge OGroimdwaterRemediation
❑Aquifer Storage and Recovety OSalinit� 11SAND/GRAVELPACIC ifa liable -
yBariler FROM TO MATERXAL E0LSCEMVfrMI=0D
OAquiferTest OStormwaterDrainage ' ft ft
ORxpedmental Technology OSubsidmee Control ft ft
OGcothermal(Closed Loop) E=r'a 20.DRILLING LOG atlaeb additional sb«ts if n
OGeothermal(Reating(CoolingRetum) 00thw( lainunder#21Remarks) I FROM To DFseRa�troN eemnFsae soaindc sv�dr-
ft ft
4.Date Wells)Completed: - - 2,3 Well ID# ft 'tt
San.Well L1 ocaaon: ft ft
• Facility/OwnaNamc Faa7ityID#(ifappScable) ft $
5'�v 1Ck lit • D 0l d 1 1.e sl-fit• C at 1�• '"ft ft
PIzidIAdan.sx11 aty,ana zip d 1'S S�Io dl ftIca
ft
CO.-' 'Parrol Mandfication No.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one Lt4ong is saffieiect) 22.C • n.
6.Is(are)the weII(s): [ ermanent or OTem o "-��2 3
p rary Si bf eII Conhaetor Date
7. Bysfaningth joisn.lhmebyeoYifyrhalthewrl[(s)war(were)consvuettd[naeeordaieew[di
If this
this a repair to An casting wen OYes or To 15ANCtC 02C.0100 or7SANCSC OIC.02001rdl(74mvz nron Standard&ad rinrt a copy
ljthu itarepair,fl[mdTmq�ra irr11 wasp WIgn information and ap[a[n the namm ojthe ojthis reeordhar bemp vWded to thecae!!owner.
rcpafrrmdcr02Jrmanbjewo'oronthe back ojth[ijonn
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closea--Loop Geothermal Wells baviug the same You may use the back of this page to provide additional well construction,info.
construction,only 1 GW-1 is needed. indicate TOTAL NCIMBER of wells (add see Ova'in Remarks Box).YOUMV also attach additional pages ifnecessary.
drilled
24.SIIB1VMAL
tal 1NST1tIICTIONS
9.To well depth below land surface:
Form+dtip[eweOrlfst all dcpth&jdffurnt(armnplo-3Q2 �2t;)a l00� Submitthis GW 1 within 30 days of well completion per the following:
10.Static water level below top of casing. G d (�) 24a.For All Yells: original form to Division of Water Resources (Dy{/It),'
ljwater[evel is above aarfn&�e j informaaoaPmOZISUnit,1617 MSC,Raleigh,NC 27699-1617
1L Borehole diameter: (� {m.) 24b.For Injection Wells:COPY to DWR,Underground Injection Control(IUC)
Program.1636 MSQ Raleigb.NC 27699-1636
12.Wclt construction method: 0
(�a auger rotary.cable,diced push,etc,) 24c.For Water Snuuly and Ooen--Loon Geothermal Return Wells Copy to the
wanly environmental health departrnent.ofthe couoty where installed
FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells urodurinL-over 100 000 GPD•Copy to DWR.CCpCUA
132.Yield(gpm) D Method of test:. P�rmrtProgr'am,1611 MSC,Italetgb NC 27699-1611
I
13b.Disinfection type:
From GW-1