GW1--05219_Well Construction - GW1_20230818

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KilirtrOl itl '
WELL CONSTRUCTION]1 CORD( P=14 `ForInternalUse Only
L Well Contractor)Infiormatioe:
Oary.Thol' psol
FROM TO:- • DFSQtl?7ION
Well Contractor Name - fb l G,t �r r1!r l
Gaol-441�A ' -/ m _
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NC Well Commerce Caniecaeiaaiatiffifia •
• 1&O11TER.CAS)N( (4 iambi tlivelb)ORMEtt{d'OP•limbic).'-••-•'•:•
Aqua Drill, Inc. •
•FROM TO MIMI= TERCENPss•• MATERIAL
Company Name• 0 GPS' .
6s2 . in. S,p({'1,t pirC
16.INNER CUING OR-TIMIiTGfa otherarldeleseiMa6n)':: :' ••• •••
2.Well Construction Permit*: 1,44�D�® a l OS-0 i,0 FROM To 0NMmrtta; THICKNESS nMArmarnu
!Arta!I applkeablewe(l coratmatonpeariss(Le.UIG Cannery,Slam,Variance.we) ft .
3.Well Use(cheekweli use): ft. ft ta. •
Water Supply Welk •
MOH TO 'Mina sL4)891ZE arncs 1}tATERYAL
0MtmicipeYPubiic fr. in.
Geothermal(Heating/Cooling Supply) residential Water Supply(single)
Industrial/Commercial
itit Ia.Residential Water Supply shared - '"1
�4 PP y(shared) •..89.anROlfd'..
Irrigation TOMA1EnrML ' , iiinnialsuirrSIIMIOD&AMOUNT
!AgrInultwel
on-Water Supply Well: 0 ft 'Z 1) & ewrill• '(' po..r 4 �yr .
Monitoring Recovery fe. ft" ‘is:fts
%njection.WeU: fc ft.'DiAgbiferR.echatge QlGfoundwaterRemgdiation • • 9..sANDIGHAveLPACKtrforaieewo) '
nAquifer Storage and Recover/ 0SalinityBarrier FROM TO OATMEAL anmaaem�iasa ors •
' ZAquiferTest QStormwaterDrainage ft ft.
ExperimentalTechnatogy 0SubsideaceControt ft ft. • .
Geothennel(Closed Loop) Tracer "20.DRILLING LOG-(attach ad Meisel sheets ifaecesnrs)
FROM TO DESCmpfoNkotar lmrdaee,:wrackry eemin wet '
Geothermal(HeatinglCoolingRetutn) Other(axpleirs under#21I€ema$rs)
O ft lb Ft- Chat/
4.Date Well(s)Completed: `/'a-�'..T.5 Welling I• ft fvb ft. n�y Sh;�y� •
5tirfl� SGt�
thi.Well Location: G d is 6 rn o.:t-,_ % '
OJ)`�I`�X.1 Gri.ue..,S GS iG fe. �,rM:,� ,
Facility/OwnerNamo - 'Facility IDBapplicable) ft. ft �— • _
ft
R i"" f-�/ L'3Liit tqS 3 t 1 4-kJ V VYi e.s 6,—i 'IN c s
Phyyssical Address.City.andzip ft f.
O�c.� lty4 �6�.� 21.REMARKS .. •" Allc:li A .2623 •
County ! Pereet ldead6eadon No.(Pill)
- 5b.Latitude and longitude:in diegreeslminuteslseconds or decimal degrees Ir�rtrtatt ��r!1'""°"m
(itwell field.awe tat/long is sufficient) • 22.Certification: •
6.Is(are)threWeI(s) ermanent or DTemporaty sr tumor eaifiexltyel! aaoaetor Dine
�� 8y signing this fens,!hereby ccrt that the well(s)u e(MIN conseucted.In aawrdaace
7.Is this a repair to an;misting well: DYes-.•or ID ' with ISA NCAC O2C.0100 or 15A MAC 02C.0200 Well Conduction Standards and that a • •
lfthisirawpar felIoutknownwelleonnruduoninforaationandesplalnthenaturesidle copyojtldsreeomllas him providedtaItauellorrnar.
repair wider 62?raaraskrsultan area the&aefojetivfarm:
23.Site diagram or additional well details
. 8.For GcoprobefDPT or Closed-Loop Geothermal Welts 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 TOTALNUMBER dwells• construction details. You may also attach additional pages ifneeessay..
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drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below load surface: 3Z_ e (ft.) 24a.For All Wells: Submit this fonn within 30 days of completion of well
Pornedtlple wells listall depths ifdgje ant(example-3@200'and:@)00') constriction to thefollowing:
10.Static water level below top of casing: 116 (ft.) Division of Water Resources,Information Processing Unit,
!fussier keel Is above auln&are"- 1617 Mail Service Center,Raleigh,NC 276991617 •
IL Borehole diameter: 6 (in.) 24b.For Intention Wells: In addition to sending the form to the address in 24a
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1�Well construction method: f d 'k+,-v A;r above,also submit one copy of this form within 30 days of completion of well
(i e.num May.able. cameh%etc] construction to the following
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 27699-1636
--13a,Yield(gpm) t 5" Method of test: Cal-d4 ite v•e - 24e.For Water Supply&Infection Wells: In addition to sending the form to
1 the address(es)above,also submit one copy of this form within 30 days of
13b.Disinfection type: fi��F� "7oJ Amount: /I% completion of veil construction to the county health department of the county
where constructed. '
Form OW-1 '-.',. '-1ti'.• North Carolina Department ofEnvi enmeatel Quality-Division of Water Resources Revised2-22-2016