GW1--06466_Well Construction - GW1_20231002

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WELL CONSTRUCTION RECORD(Gw jZ i nor s�a[� i�,a_t —. V
1.Well Contractor Information: e
Walt ContraeearNen_ FROM itt8lra01 I — .
f!, fit, f
CIS-( - —
NC Weil f'aam5tor Centiatr ionl+lumlxs
Morgan�tY��l�t Pump,INC :-:11:O(1TIMASlu, W pion Jn 1se4 r .Im l,r lc
mai TO owns=R t 1 TERCKxrc MATERIAL
-- -- ------- __— 9 ft, j ft, 61?8 s 31 P11- r
CommoyNome
;'.1 hide ..- fflORTI ( 6krA 1 4o p).-3 :::
2.Weil Conatruclian Permit vZ `O rsq�)se l. FROM TO DIMORKR t I CRI s MAMMAL
,tis'1aAappitcirble well ma ni 6 fie_c&o .iild Cos 0'sreue,frvlance,eecJ ft, ft, in,1
3,Well Use(ch_eckwell ow); fit it ie
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Water Supply Wel atom To D AdETR& �f+� � rrfittFss dATk RiA
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DAgricultu ai Eihgncipa_/Fublic re- Fe.
in.
4ceotheema1014tinV/cgalin3 Nappy') ri°-genital water Supply warmft, --- t
L?ldo*ia fco umt3 ii s:a''-tial Woes'SuPA>�'( e r;ls fatotrx- ;. ; . : .
',Irrigation FROM TO MATERIAL.- YRtt'LICEIiENTMETHOD&,AmouRT
Non-Water-Supply Well; 0 ft• 20 IL bore elte poured
M sitoring D ft. ft, ,
nje. _n iliz fa fs
Aquifer Recharge riCnoundwaterlftesnediatisrs As SAifBlt ' �ts ei.f'- _ =
9Aquifer Storage and Recovery DSelittityRanier t ----- TO _ E+nPlat stFlVri+sErHote
_ Aquifer Tat InStomswate€Drainage ft, fit:
3P>xprrim€ttlalTechnology EISubsidence Control ft, It
1Geothestal(Closed lmp) Maw2a-liiitt IFIgfkt-bitt35ta et9nA sheets trialie i yl = - :; __
FROM TO .WgiC�RIPTION(okra,/,_ — "Mrs&ORF.Erdn oltc.ns.1
IGsothermal flienting/olingReWrn f Other(explain under tl l rtusds-sl 0 i. it 4 ft, 1',pl 11 l l
4.Date Weii(s)Completed: Gf LJ 13 Weil MI - c‘0 [s, 6 1+r('i 4 -
Sa,Weil Locations h�t' 0 - IL"C: l�
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in Coe - _lit - fc.oft- Ate .',,�.6 fovw ,'T�
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FtaillrylO :Name facilitylD6th' liaa_ble)
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Huske A ddtms,City,mot Zip • a —
County Parted identificsion lain(PIE!) --_• 5b,Mande and —
long-Rode iat deglxeslinlltute s/aseonds or decimal dogmas —_ — ._.--____
(ifwcil field,one lstliong is€af ielent) 22,fi r19Ctcallore€ j Ct`r=.r LA i
3s.g13413 N tC1. c 1 . W
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b.h(ttte)the w it(s)�Peannapont or �refnporery sir_ tttt4 cllt onetur ; ; pats ',
Ay aivnlag gigs farm I hereby csrt f them:fie s (t)ere$Owe)ceminrsted in aceordancc
7,15 this a•[elteir to an existing well; ®Yes or EIN6 with 15!NCAC0-C.0100 ar 1 M N te'e1C:0100 Wstt CoierntecMN,Slandewds and that a
OM ita rrpdr fiffMO k mot or:ii,commacriontafornOefoa aryl Wain dhsrtot t 4ihs alP1eats mord MY bsrrt Pm/d.gd1#thr m'',moron
rrpgirteuferr21rrmark.aarionmo Mike bock ofrhtsform. 73,^bitediagramoLr additional welld t_9Rs;
$.For eprobe/DPI or Closed-gip Genthe:rood Wells having the swat: You may use the back of this pee t*pti+vide additional well site-details or well
eonsttucu.'_o only t GW l is needed. knilente TOTAL NUMB R of wells lion details.You may also Ova additional pages if necessary,
dulled:! SUBMITTAL INSI'BUt rio t8
9.Fetal well ftpth belawiand surfacer (fit) 73a,For All Welk: Submit thb(afnt wititio 30 days of completion of well
For mokiple mils llrtalideo*:Vet- W(mompk- O:WO'atrely01807 constmotiontothefollowing;
•10,Steti water level below top of sings --� 7 O r at) Division of Water Resorlrees,infotetinn Processing Uaslt,
/flower lead is draw cash um"t-" 1617 Mail Service Center,Ralei ,IYC 29699-1617
11.Borehole diameter: t{(8 . 0'} Mb,For Inledion Wells: In addition to sending the form to the address in Ma
•
*ow,also submit one copy of this foci within 30 days of completion of well
II Well construction method; ftltdl — . oottstsnetlan to#1re fallowing;
f moot::,tot4y,ea61a,dim,tpush,tit) __ —
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Division of Water Resources,Undargroand injection Control Program,
FOR WATER S11T'?LY WE.I.S ONLY: 1634 Mail Stynoitro Cetttxr,'ltaleigh,l'iC 27499406
13a.YteJd(gpm). 11° - Method OMB;air 24e,Far Water Sanger dt Injection Wens; In add'uion to sending the farm to
gr +atasststbhirm - _. - the eddre*s)above,also submit Onet opy of this form within 30 days of
lib,[Disinfection type:� --r_-- Amount: � )1 completion of well crltutruetion to the county bcaith department of the county
FesasO.W-1 blond:CamlirarEton_nrasntofThwinonmuclQullty-EnvisionotWetcrhesooma RevntAt2 -2016