GW1--06467_Well Construction - GW1_20231002

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WELL C[?�'+STRUCTION RECORD(GW==11 "Fax In`w anigittr3�y"--` ----—
1.Well Contractor Xnfornuttiont
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WsitCCnt[eetcFls YROM— TO Inla Urnirr _ — -
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NC Weil Con torCertlficationN r —
rLxl'liz QlRCtiSfi"f�CfochuE¢ �? 3t ai � Lif9ERCct;�',Ckable ,-.,, ..:-•-�
Morgan Well,&Pump,INC nom TO DIAMETER i 1i T rrcatUS MATERW
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CorupnyNo e _
� -Vf /� .:36 INENLVA�SINGrOR IBI G fgiciikrioaal closed-4110 :. .
2.Well Construction Permit if: `
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f TRIMNESS ' .f1fATERIAt.
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.Lig all app?kakte wen cm:maimApermi cf ffiC Comfy, P ,de.)
ft- ft, in,
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3.Weil Use(cheek well use);
yyetr rSnpplY Ws11 l7=SLlttg[?tf .
FROM TO UTAtliETin ,. S[ATSt� TInoir*SS )dlA't'ERIM
Agricultu al I .... icipeYP'gblic iti-' ft, io
tt etmul,¢He�Ating/Coolinn"Supply) >_i p: ,idenual Wino Supply((�Siin lc) - l+pf/L=�,r,,- fr. _ la
1rlinCithllcouimgrutltl �:Ftaik1Cntill W4te1' 1k1 t5 d) -::i GROUT,;:t..,•r,:.W, 5 ':i.','.:_::-'.�.,:.:.:.'�-;-:'.i i.:i
L*riglltioa mom 3'--_._ stATet:ur_ urt.A.caaaarrratt ion +' oui;T
Noi Waiter'Supply Well: _ _ n rt. 20 rt, bstttoniSe WO
Monitoring ®lIaovx ft" M.
PJSCr p 4Yeltf— - ft, ft,
narlRccharse E]t roandwxterRcmcdiation r`
Aquifer Storage and Recovery in Saltily Rattier FIRMA TO MA'rgQlAL - E TLACC tJEtffl aV109
Aquifer Test OStonnwater Drainage it, 'b'_
Experimental Technology OSuhsidenla°Control ft,
atheimal(Closed Loop) fL�xa l*ltI aea;ro t ttuissif tkresaa ) •
FROM nk r.'R1PTION(eater.
_I TO - ..- -. 4udpean.sotnsktypa own 31ler �a
Geothermal((geutingWCgolini ) Othts(4x lain under.f 2i Remits) -_.__ -
0 f� it, 1'
A[Date Tel_l(s)Completed 2- jwell1P# -- 1 0 ft' (1eO ft' CA,(O A L/�i
$a.Wel Location: 0 fL ft, w,
g('t<I\Alan l
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Fa�illty/4vw rNamti 6ast'7i,ism(ifepplkosblc) ----
Tidal Mtge,Ciiy,and Zip — ft. R o t_P ...i' L.
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( Is rlL.KERIARKaS.. F
County P edtdsntlfieationro.(l'Si) QrT 0 20.
3b,1,1110ude and longitede in deg reslminuteeisecoods or decimal ruse -- -- - I n. s;lam '-�3.tin!'
await field,mist/long is sufficient) 22,� ;tirration: p O'..'.'0L,
0, 5 pY
6.Igo e)tbsae9(s) X lrermant nt or DTeIJtpornry Sigiwrxresgft saw+ Wd. -.or PAP
By*Wm akin foam,I hereby we than the liana)ruts(,Este)conarrucced in accordance
• lb this aA r tpoir to an es istipg well; ®HSs or Eli% with IS.#MAC 07C.0100 or LU NOl'0.C.02ol7 IFaa Corutnicrfan Standards and that a
f tht+irar r P ftl age known nrii construction informagan e n beviEfn etc mar?al* coif" his resord hm be, Jiorhe 1/04 4r.
repair wider VI moor*?raetion Ryon the bac,EoJthftfonn.
23,Site diagram or additional well dst?Lts;
- 3,For Ger<probsIPl''T or Closeilloop Geothermal Wells leaving she sate You may uae the back of this Da3e to provide additional well sits details or well
mmstrusdoo,only I t is nt did, Indicate TOTAL NUMMiR of wells . comma:ion details, You My also much-itlsanal pages if necessary
dr7hxt.' ptUBMITE U.iNSi'RUC'TIONS
9,Total well depth below land4urf e: -_ 1_ > -- _(a,) 24a, For All Wells: &Wait kiis form within 30 days of completion of Nvei1
- FirmrnlrJp mils hitalldephrIfifOrr t(erampts-3A_-'An'aat2 119) cuaSlseti0nt0 f4110Witt
I .Stade water level below top of mi 5 (ft,) Division of Water Rooms*Information Processing unit,
Irmo level fs above carM&arc"4." 1637 Mai Swaim Center,Raleigh,NC 276991617
!!-Rorv:dmole dlaltteter:6 1/ .._ [t4,) 2.4b,f or iniedion Wdtst In o_dditi4n to sonding the for..to the address in 24a
12,Wall construction ntetltod; rotary abuvc,also submit one copy of this n within 39 days of completion of well
--_...- _: - construction to the following (
(i.e.art,rota"sable,direct push,etc) •
Division of Water Resources,(Iate€groonsl Injection Control Program,
FOR WATER SUPPLY WELLS ONLY; I636 Mail Service Center,Raleigh,NC 27694416636
13a'Yield(gem) l%sW_4d of_ SLR&ir. . _ gee,Ear water Supply a•Infection Wens: In addition to wain the foam to
mtdateoehbprinc tits addresses)above,also submit one copy of this form within 30 days of
13b,Disinfection type g
--� Aruo nd: Cr 6Z completion of well construction to the county health department of the county
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adatra consMIcted,
FcnnOW-I Notdre,OrPllnat nmeetofEnvironmentalQuality-DtvisfsnofWatsrBesousscs RevneA222-2016
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