GW1--06481_Well Construction - GW1_20231002

'..tIli#F:orrn
WELL CONSTRUCTION RECORD(GW-1) For IntEt Usn Only: — - .
1.Well Contractor Wormationt •
OIU -fie t :[4,-WYA7C NES,: ;6: _";'s ; : - -=^'•;:.:: - -
Well CoiuraatorNam 11 TO
AL'SCRt riit4Y 4 ._ �s
ft, ft.
NC Well Contractor CattifiadonNumber
:45..OUTERTCa:Etafi M`Olti ORLINEla:tte-` teseae -••-,
Morgan Well, Pump,INC .nom TO DIAMETER THICKNESS DrIATEi�IAL '
----- - -- -- - ------ --- 0 k 14 Z ft. 61/a f,a. sdF21 PVC #
Ctmtpa+ayName "16':1Ai1f11 t,A.^alN <OR_JBAYG{jeottxiamaIctosc44`_ ".'
2.Well Comradian Permit t 141
norm 70 ODAMI ETER THICKNESS MATERIAL
-
.ttoanloptkable twit�mama-kispaamtttr�t vII(malty,sTatte,Variance,etc) ft. ft, In.
I Well Use(check well our fa
_
r _a !1r sd:':;. .� � .� . _ :•.� < ';
-Water SupplyWel TO nTAalawit SLOTMK TilCKNss -m.vrEst+t, �
-
CiAgricultusal Ell cipaYPublis ri, .--- la-
DGeeotitetnial akatin$/Cooiing Supply) Residential Water Supply(singlo) it, - rr go.
Il112dusixiaUCotm etels1 RcsrcdsntialwawSit- B (s_lwred) ritni 4t , x ••< ,-
ILTTIRatiW1 '�n� TO MATERIAL. EMel.ACEME'ir amnion&.a. •IINT
Non-Water Supply Well: - CIrs, 20 r' bsa,antts pacrad
LiMoaitering EiRecovery ft ft.
nfect/on Welk- ft. _ — -
DAgniferRecharge fOroundwaterRemcdka_tlon n.- A/ RAYM ACIC - ,cable r ___ ;.:
DAquifer Storage end Reeovsry rir.ahnityBarrier Moat: TO At,! _elAx - EMPLACEMENT METHOD
DAtluikrTeM -_warm ft. ft,
�3Sotm 1?rainags
0Exparimental Tiatmoiogy ri$ribsidencr Control rt., fr•
riG olhetmat(Closed Loop) faTrlter `03)11tu iN41.11G aaoir,0a!l Wets it n) s x:*'
�Sieo+ erinisl{lleatin CQolini RaOt n) rI4dtsr{e�tDlaltt f l l eettnrks) �e o� -�ra _ DESCRIPTION took,:Wa„as.s,r West tow��n ai:c,a0a
I rt- .L. ft- t /a /4 '/s4
4.pats We l(s)Completed;°1 1-$�3 Well LDr� { 2 IL ft. ,4!o✓✓\ i(1D61,,�',p
a""0.Well E,ste3tiQcit • 3ci ft. 65 f due. rave rye,
fa ro ______ e F-..
(�e�,l (3w Ides
r I;aSilityl ._ S�srue (: epos -- ) .r.`
Win, rf t?ra61y .-� .=•�c s-�1'±�i; 1. P&Physical Address,City, —zo tt: ft, I :::41: 9 c 1
County - - Parcel identificatiionNo.(PIN) .-`� __,,,.-, Prr 6•, ..,�g lira--cam=---
Dt,
5b,Latitode and longitttde.in degress(minuteslsecoasdtl or decimal dee�rrest —... __ --
Orwell field,one lat9IIng is sufficient) 22,Cer _ficaf{o •
3S-37501/ N L_/- 72. w 1
ot_led6,1s(atee)thetselt(a)MPermari�ent or f Temporaf� Sigma-Ica Wall u+€ Pate
Ay*ping thtt farm,I hereby cet1(0 that the we((r)rtot(woe)canttracted in accordance
• 7.Is this?i repair to an existing went ©Yes or �R No with 15.f NCACO?C.WOO of 15.d MAC' Weil Constrardian,4tandardr and that a
>/thlt bra rcpplrfdtaarhnale7; lt contraction tafarmaitan anti explain the naPreelk =FY elkii mord hat herr_,RmvtdartotheKssllakx
repair taterr621 remark ttanOronMc hack oflhitfarea
gd,glee di.gram or additional well tlstailr,
8,For GeoprgbeiDPT or =Loop Geothermal Wells having the some
You may use t6o heels of skis pace to pam+sds additional well site details t r well
constraca ,,only 1 OW-1 is arced ed. Indicate TUB ALT C(1vlBi!A of wellsconstmetion x4etaiis. You may also attach additional pages if tlerPssn±,.
drilled; SUBMITTAL itV$TRUG'I'xONS
9,Total well depth below bnd surface;__ / , --.- (1 ) 24a, For All Wells: Submit this form within 30 days of c�t¢pletiou of well
Formwhiplosr�slfsilnalldepatil(atrerent(srample-3Q2 cut42 JOO') COSISSIHgtiORtothefoliowi_ng;
10.Sttstle water ietel below top af callus; {it) Division off Water Resources,Information Processing Unit, .
{P>4ater lard is ahare casing for"4" I617 Amyl Service Center,pomp,NC 276994617
11,llorehglt diannetert 0_1/8 (ha) 24b,Pr Ilnie etiun Wells; In addition to'sending the form to the address in 24a
• above,atso submit oone svpy of this Donn within 30 days of completion of well
rotar12.Welt scnstsuction method: _._._ ..___. a. canswetioa to the foltovting
(i.e.sow,evt ry,cable„direct push;sic.) !
- Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Center,Raleigh,NC 27099-1636
I
13a,Yield(Pm) (Z _ Melb4w 4l te5tt air _ 24e Far Water Supply 8-['limiest Wells: in gti4ition to SCDdi g tlsa form to
the,,ddresges)above,also submit Omar'copy of this form within 30 days of
i3b,Risirdeieti4aa type;s" at°d 1e _ Amount• 4 ' 5 0z completion of well construction to the county health depattmenr of the county
where conuruetea,
•
Am COW North spume_inof 7ronranial�Gty-DivisionofWatsrRravuccss i Revised 2-22-2016
I