GW1--06482_Well Construction - GW1_20231002

WELII CONSTRUCTION RECORD(GW-1) .
lliiiIntgwaTUse 070-6T:—---- - r _.Lerm I
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1„Well Ceiftyeetor Information: .
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.aw -7 .....-, --
•14,-*ATeition.:5;,,,n-gg,- , .,•,-.;...,•,7,..- -4,--,.;,•:.,,i,::,. .,...,.--.7.7. 7.-
Iva Conapopriland . FROM TO niki—iJirialrif . .41-GCG---11 ft, fr,
ft, ' • ft, — I.
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NC WI Contractor C.crtifira 4
tion" Number
:1,54 OUTERCASIN ruat mnid,eastil:nifliTilft LINER le_ litabfiI) .1-:: •f:
Morgan Well Pump,INC -)ROM TO DIAMETER I IMCKNESS .- MATERIAL
6 e iti3 ° kk-21 PVC
Corepsoy Nom
;i1ClisiNEIrtfiSDPICiRttiBING fiititietieetttiiiiil-liiity14.:I;•tir:: :T.:7,-;.7-:-7:T.::.7
2,Wel C01151111011 refatift I III 9.1), FROM TO DIAMETER 1 TRICIMES5 MATERIA' L
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Mit all appikriblo woll commotion permsitr fix 11:SC C-Ohntrv,Fon'r,Voriarico:co.) ft. ft nt I
-
in. ; •
3.Well Use(Ant wdl use):
17„SCRtiit's.‘:-. ..!.4,:.---,;:-.-.5-A.;---. :,-,..,-'•"--,:g-rt .r.'i::I,"-...:'.1'..,._.
IVuter Sufi*With FROm TO- IDIAMETEI(_ kn. StOTRIZE_:TIIICKRESS MATERIAL
13Ag4isttltur41 DbilmicipaVt.ago ' fir, ft ,
DeNthr4934 Meeting/Cooling Supply) riftiesideritial Waxer Supply(single) it ft, ,-______
la 1
Etiedusitial/Coratecteid 17:044dwial w4t4c 8I-TPLY 4harcd) at:GROVE`'',.',":4;:*•-.);•••,"•• ••1:,:5. i.':''',:"•••4:-..'-,::,;',-.A':: •,-::-5,,,;•1: •7::'::';••-'•,':,•'::'.-':',•;.•
ribrination FROM TO mATER1AL EMPLACEMENT METHOD 4 xmoun
Non,Water Supply Well; ti ft.° 20 (1, bvitonitt poiXid
1040.ar.girig nRiXOVPry ft, --fi.
_ _ _- __ _
lit*ITOWt Weill ft,- ft,
0 Acriikr Rgrilaw 171Crroguslwater Rcolottietion
DAquicer Storage end Recovety faSelleity nattier -MIA— TO- Platittia. EMPi.ACEliElli Wallop __
f3Atutifer TeSt OStOrinviater Drainage ft, ft. I
_
DExporintentel Tockoology E)Subsiclence Control ft, fr,
13Geotheanal.(Closed Ixop) ON= -3prOftnnatG L000ttach1446014 Weeks iftieeeidaii,1 -Y••:''-% 2-":.2'-:,',< :'• "
-Trim% To t in,SCRIVTION(oolsr.bvtlatnsalYrock que:iguin-atm sm.)
rtgRothalllill(1-leatinuSuutiuRAum) Miller fexolein tinder MI Rematir4) ft, '''-'----- ft, i
4S=1-9,
4.1late Wcii(s)Completed;.3 Well ID ft, -
Ea,Well Locadont ,
ft, ft,
WI<-• Z_e...i/loirli
ft, ft
Facility/Owner Name. Fealty KV(if epplicatio) ..---;:7 1------
- -
ft. ft
r C
ezt .p,_r:5tr ___ ____
hysietti Ackistos, mil ft. ft,
7-- - --'-.-- - • --A>,,.- :0 C T 0 2 20-23
claSi---oti • ...-21.:XEMAIIKS-w,---.--:t:.,.,-:"....,:z...-.:.-::.-: ...... ,.
County Pamul Icluntificution Nu.(PfN) — ____
. ! DVI.:Q1SOG
511,Latitude and longitude in degreesiminutes/seconds or decimal degrees: - --
(Irwell field,one'Monis sufficient) 22,Certification; 1
35_110523 pi icl 27 I Gy
, w 1
. , .
$ignatlira ofecuPLI Won Comecon- : Date
6.Igere)the weft(s)larermanent or riTemporny
fly signing Wriest"I hereby artily shot the iiffift)rcos(wow)sononscol in areorsfanco
• 7,Is this A repair to an exi,sting Well; Dyes or OM with Ili NOW VC.0100 or MA NCAO 02C.0200 Well dostrouotion Ranctortis and theta
pug t I a ropoir,fd 1 out knows pooll cortwuntion infornsarloss and(*Wilk two:rev/4k copy;Phis mord ha brim pooloird so thr xvIrowner.
!
repoirontfir tat remark l gentian or on Mc hack pith&Arm,
23,Site eliagram or addittoindweS details; ._
•
You may use the back of dis page to prof/1de additional Well site-detalls or well
&For Get/probe/DPP or Closed=Loop Geothermal Wells having dm mac
I OW-1 b needed, Indicate TOTAL NUMBER of viells coostruction details. You nay also Melt additional pages if necessary.
construction,only :
drilled:' f:IIEITTTAL INSTRUCI7Orea
9,Total well depth below bnd surface: 2.(16 __#.0 Ma, For AR Wenn Submit this form within 30 days of coPletion of well
- For trosikotesiwitslirt oil*paw iffftrent(mitiple-,,M200'old;2@te(F) coti.stitistOsi to the following: 1
10,Slade water level below top of easing; ".3--0 (it,) DiVigiDD of Wafer Resources,Information Promising Unit, -
INPUT kW:is above caries,use"+" 1617 Maff Service-Center,Ibisith,DIC 27699-1619
tx,Rorshole diameter6 1/8 _(i_n4 1
24b,For Infection wens: In td4itinn tv rnling the form to the address in 24a
12,Wed construction method:. rotary
• above,also submit one copy of this tRIO Within 30 days of completion of well
construction to the following: 1
OA Ma,rotoy,catio,Meg pose,eta) — I ;
- Division of Water Resoorces,Underground Injection Control Program,
FOR WATiR SUPPLY WELLS ONLY; 1636 Mall Service Center,Raleigh,NC 276994636
iu,yield(gpm) 10 . igehod grow taf 7.4e.For Water Supply&Iniectim Weisz, ]i addition tft smiling the form to
the eddresges) above,also submit one 8opy of this form within 30 days of
12b.Pleoffolinn tYP4;want" " ,... Amount; 1 7,• Oz. completion of well co:tamed=to Limo county health department of the county
• _ _ wbeic constructed, I
Form GW-I North Carolina ftepartroent of Enfici,...ntel Quality-Division of Waicrftcsooms • Revised 2-22-2016
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