HomeMy WebLinkAboutGW1--06378_Well Construction - GW1_20231002 • 1
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WELI,._CONSTRUCTION RECORD(GW4) rPor Intern•X Usittolr 040.0..
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, 1,Well COTITT1CtRr information: •
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NC WAContractorCotifitatloali-tabcr
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Morgan Well Wok&Pump,INC FROM TO otomin t VILLICIOfta JJ!1ERML
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Cortgooy Mint
r1 II ? 'la.VINIERIC ; Itlaltta taltIttitinilttatif,46±41 1:.,i:e-•i :-::-:-: ..--.....-. .-7"-F.,
2.Well Construction Permit#: 4" 14.1 .--- TO . _num= f I Tin a.,i" MATERLAI,
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listed 1 applbrable nell coreirivaim . re-4,E=Caw%.F.ov4 Valance,rite) :
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I,Well Use(cheek weft use); -
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Water Supply Wel FRO111. _2ro otAmETEit -SLOT STU TTITCRREER MATERTAL
jit Agdwittical 13)kniolpalfFoblig
a agothamil aleating/Cooling Supply) MItesidentiel Water Suppky(single) - fr, ft, hi -. . _
i Iruincirial/Commquial ORcsidalfial Wag!SWAY 004 KILGRouTji!._1;i:„ 4.,,.!),,,..4,1,2„,::..t iI:-.."•43.',;',:f1',:.".,i.",'_:::!„,..,:.-i•-.!...--:?-.,.5,-- .:.,:;-;:•-•,„..,
mom To "mieiTsliit. . VMPLACEmENT METHOD&A744:31ffirr
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Non-Water Supply We31; c 4,. SO rg' ITaMMT.c '' ixTgreq
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0 MoTACMITE 171114:0VRTY it, fr, i
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_ru in n 1.411 fr„ - fr, — ,
ii AquircrftgbariF 1:10to.=Water Remcdiation
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Xi Aquifer Storage And Ermwery CeSalinity Denier ---FIWW-1 TO -----11,1 117 ,,. _ EMPLACEMENT METHOD ,
I Aquifer Test OStonnwater Drainage ft, ft. • ..
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i Experimental Technology OSubsidence Control fr, ft.
it Gtothcosol.(Closed Loop) DIrsog 2:03)ntlizsiGLOG:cattedistsnnouge.rifetStril
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- NI (14SEtiRWCORERR Ram) 9 Oer th (explain uoder#21 RelowIts) - 0
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&Date WO)Completed;Ai. 0 Weil 1D# 61 0 11-. /0 l'' i'-'72. UNitsi cl ri
Sa.Well Locadon; • 7)•0 4, ,..1 L ft' PO Vii"ttl i. )
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j/1 (V if1 ;,21,11W4WAPICS.97,:.,A.''''','':,'-4,7.',..!',",','-.r r-T.,`_2::,7-:,..-:-1--,'''-' '. ' --
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County Parcel klentification No.(PIN) . _,
• 5b,Ladtude and longitude in degreesiminutedieconds or decimal&green — .• --,- -- ,
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tifwell fteld,oneVlone is solderers) 21 Cerd_Ration; DV;ia;rf,'D-C1
. Sc,C-rq 11 - N q I /90 i 7) W
Signanter&tredf Welt Conunetor
6.Kate)thewell(s)61Permanent or nTemporary
By eyries Airfare%I hereby ar10 rho(the vvta.()anal(were)ea me-meted In arzontance
• 1 Is this a repAir to an existing went laYes or MN° ivi MA A i PICAC 07C.MI4 a r 154 NCeC MC.02 Well Conrirecaen Raeder&and that a
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rad!(fa repair,j111 au I home weil caeravariaa iritormatioe see I ceplain thegarwe gigs WY Oafs mord ha,berVrevlik-d- Rabe ive. 047gr.- .
repair wieter#21 meta*seeder:erne Ow bark o f*Ore%
23,Site&worn or additionalwell deialts;
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You may use tbe back of this pap to provide additiOn4 Weil site-dotall5 or well
8,For GtoprobtRIPT 9r CloseiLL0_op Geothermal Wells having-the same
constmetion,only I GW-1 is needed, Lort woe TOTAL liGht9:91,awcils asestruction details. You um!a_Lco ettAcia additional pages if necessary.
kl(1133417TAL nartrocuopr_s_,
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9,Total well depth below land surface; e20 A 0.0 24s,For Alt WOW SOMA&IF MIMI Pam: 30 days of completion of well
- Farm/11M iorlh•lira el 1 depth:ifiliff emir(exam I e-30? °ea 4 Atiair) • =situation to the followinx , .
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10,Stade water level below top of easing; 3. e 00 Division of Water Resources;Information Processing Unit,
• livelier kiTth above=ins we•*" 617 Me Sesvice Center-,Raleigh,NC 27639-1617
11,Borehole diarnerArt 1/8 (in,) ,
241r,per Sofeetion Wells: In Warm to sending the form to the address in 24a
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ol above,also submit one copy of this faint'within 39 days of completion of wall tWaurrtil,comirticabbranamiliotp1:474tarY____ ___ .._ ..__
- .-_____________. construcdon to die following:
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_ Division of Water Resources,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY; 1636 Mall Service Center,Dalcigh,NC 276994636
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itgit.yidd( p,„) 3 .., ,,MAW rif ogst,.•air _ _ 24e.FOP Water Snooty&Infection Was; In WM.=to=paw,the px.m.to
the addresges)taboVe.,also sibmit one. army of this form within 30 days of
on,Dronrection type; -414-ilif:a chkwift _ Amount. 1 0 i completion of all construction to&county health department of the county
- vohere construeted,
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Poen GW4 Noel;Carotin Departmcm ofEnvlosnmentel Onstity-Division a WaserEssourecs Revised 2-22-2916
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