HomeMy WebLinkAboutGW1--06379_Well Construction - GW1_20231002 I
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WELL CONSTRUCTION RECORD(OW-1) pox xnktniiikianir,
. 1.Well Contractor Information: _
Well Coauacter Nan_ FROM TO DIS-
ft; ft-
44/--G. (rr"ii
NC Weil Ceetractcr Certification'Number , , .
Morgan WWeli,&Pump,INC -FROM TO DIAMETER aIMCtt<y1:Ss ma►'neRIAL •
-
__. _ _ _______.—. . _ _ - 0 ft, ft' 0411i 141 lsdr2l PVV f .
Comply Name . • i•. lti li�'�V1�?C 'PRIT IP faietite it[stoscC-4 t .: '
R�,1• l '� ?ta • ®LAlti1 �eEt TRIMMER M ArtxiiAt
2,wa construction[permit#;1:2..._ .. .3 lk(91,j ft,
btsrait applkttble tissll Rvrutractinnpwnrttr(i UIC r ytrn(v, Parlance, ) - .- __.
Use(sbesls,wal tune �r. ft, i
peppy s
3.Well
_..- .`7-:_uses++:'1_-".(:�: _?.y -.-_•
Water Supply Went MOM TO WARtty7YR nor SI : _TRICKNESE MA RIM,
1Af,IIS ltUIa-1 phihmicipaiRehlic ft, ft. in.
Cieotherma1(Heating/Cooling Supply) Aeakiential Water Supply(single) --- rf,- --•fe.
lttdttsYsiatVCttuamet l ftidaltial WM r StIPPIY 041440 '?1ts;C 13T' x .«'' :,;;� x _,_: :3::.:..: .:
)LrricatiOn FRO
'r `M-MATEQw. ` ianciCE 4EN AMET'ERO_n£kicouA-T
t+iery Wets*Supply Weil;
9 . II. 20 rt, tkaggog_ poured
Monitoring nRectivery P., f`-
'�n#.e Walt ft, ft,AgnifctF' tsar �trroptidtvaterl?etrirdiation ,meAND/fuirui3f- irp +f`tcabl:ey;•s:: 5=: _. ... . . ': t.
Aquifer Storage mid Rccovexy �3nlinity Denierttltoas TO MAT 3 katrr xe ?tern aVttlo4
3Aquifer Teat
StOnnwM Thai_nage ft, ft.
Experimental Technology DSub;idrn a Control ft, ft
IGmtkanal(Closed Loop) [3'« ' pBu LINGIG A:[la:Uttieradt i arati+tis ft_ err_ -1 •.;'' -::__::_
IQ -VESCRIPr1ON gyMr.Rand. rock type,Brain size,etc.1
• Cimb:rmat(Heating/Cooling�R-ettan)SJ%rafter
�t er(explainmidet'l l Rognarlts) {'J n Jr411�A
4.Pate Wigs)Completed "Well P -T R' ,���r-0b�� � fie.I
fa.Well Location: [kW ['1 tr CM rAn i
Y.
Fa_c'ilityrOwnerNmee FaeilityID#(ifapplieehle) fr. ft-
•`�y�11 ft, R,
a7Ti]_iS �
te. Tr_ -ft. ft, .
1 City,and Ztp
t 2t REMAJ r v .` twit e•,.'i.
/, ��/��� t - 4 - .:LIt ::i: �� .� v?.'h' .mot`/:''.
County .Percel Identification No.(PIN) --• CIO0 2 fQ13
5b,Mlitads and lonitside>n degtreeslfitinutesisseonds or decimal deresst -
{ifwell field,oec latt/long is suf"telent) 22,Cer n' / ..- ;'r:• -3 1.20.
`� /�/ 1 int..tr , .
up
em
6.1s(2upe)the we0(s) rerinanent or f Temporar}' Si,•.' s tt� WeltSmti for r P
Sy ntgnini Oat form,I hereby ceiiii3 thor the WIN t<att(me)crin:Inwtsd In aeeordlncc
• 7.15 this rt repair to Ito existing welt ®Yes or Dio with Ad NCAC RIC.f1P9 ar.15d NCACO2C.0200 Weil Conxan:onaa Srandavdr and tied[a
Oda it arepatrfdt au/known wFRranamantlantrfarmaatwt and caplatntheImreafAs 40PPITIMI mord ha hem P!otrfdada2ncgilx!!oµxsr.
repair ander#21 remark weion or an the back ofthirfone. •
23,Site diagram or additional well details;
$,For il`,eoprobelDPI'or Closed-loop Geothermal Wells haying the You anay use the back of this paw to provide orlditional well site dttails or well
sonst_tnstion,only l 6W-1 is needed, Indicate T(iTALNUMB1 R dwells coosouction details. You may also attach additional pages if necessary.
drilled:' SIIBMITPAI.INSTRUC I S
.`l r
9. r
Total well depth below snrfa.et _.._I�b_j__ __tf�) 2#a.For All Wallet Stabtait this foi*n with 30 days of completion of well
for maalrtplemat fit alldsprhrtfdifrrant(exampls-3�?PD'on42010p') cousbuctiontoritefollowing;
10.Stade water level below top of easing; b0 _ f) - Division of Water Resources,Information Processing Unit,
YwarerlaYl is above catln&use"+" 1617 Mall Service Center,Raleigh,NC 296991629
11,Laoatsiaoie diameter;6 9/8 (in) 2a13.For Iaieerien Welts; In a_ddihio to sending the form to the address in 24a
12,Well constrestion method: rotary_ above,also submit one copy of this fomm within 30 days of completion of well
(1.4.ma,rotary,cable,direct ptLSlfr etc,) -. constmetion to the following; �
- Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Rell:igh,NYC 276994636
1
13a,Yield(gpm) I I Method of test:air let Far Water Comply BrInteetitta Waist in addition to sending the fpmt to
.JJJ -I° j c, the arddress(es)Move,also submit grtel,copy of this form within 30 days of
lab.Disinfection type;grattfaisdchtgrlae Amnuat tf "3 (•
_•. completion of well ctmstntction to the Bounty health department of the county
- — wherre constructed,
•
Form GW-1 Nod r.iMumma of EtwitsamsnttI Quality-Division of Wateritesemees Revised 2 22-2916