GW1--06933_Well Construction - GW1_20231027

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- WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
L Well ContractorWnfonuanon
3944 g. TLia.j.1, !'S -- 11.WATER ZONES
Well C nanor 3,9?C. aPROM To . DE9C1MPTIoN
NCWdIComraeo;C Number /P5- ft /� ' IlL der tA"hi-e- Sale!*
/J� I QQ ]5.OUTER CASING(for rimltEeaselwem)ORLINER(if )
l.J'e4iC (��`� S ata+�7t'1"J L ` FROM TO DIAMETER TRIG IMMORAL
C�
ft. ft. 11 in.
lit INNER OWING ORTUBING( deed4OOD)
2.Well Construction Penult It: I5#176)`" • PROM ID D/AMEIER MATERIAL
List all appliaabb3>iwII aradnuxianpamits(i.e.IIIC Comfy.smtR variance;etc) / It /d`a l in- Nh-. -)UC
3.Well Use(check well use): /1)f /b7 tt ,L!I to. 6 vt...v.0 (Arc_
n Water Supplyw - . . 17.SCREEN
�Agiadttual 17MimitdpallPablic PROM TO -DIAt SOMBRE THI�t� MATeRT L
/up a /DS'nt c1L (i'!. • &d 3 a 4- -
OGcothmmal(HearineCooling Supply) °Residential Water Supply(single) it. it. ;in- Sal"lI'Ss> jk,4p, - - .
❑Industrial/Commmetoial ,t�esidential WaterSupply(shared) 18.CRour
°Irrigation DWe ls>100,000 GPD PROM TD MI AL Etell.IACEBIENTMETHUD&AMOUNr
• Non-Water Sapp gwdk 0 Q' c /f�'e.p�_ p ol.Iw�"
[Monitoring CIRecovery ft. ft. -
Injection Well: -
°AquiferRai>arge fGmmuldwaterx of ft. it. • �'
19.SANDIGRAVELPACKfif.iii lie)
°Agmfer Storage and Recovery °Salinity Barrier PROM ID MATERIAL EMITACEMERTMEIROD
°Aquifer Test OStonmwat rDrainage 2/ It !,j)7 n' *- 1 _ pa
°Experima►Ml Todmology °Subsidence Control a. R
°Geothermal(Closed Loop) CIPracer TO.DRILLINGLOGbattachadAdionals Uncanny) . .
OGeothemml(HratingICoolingRetam) °Other(explainundcr#21 Re ) FBOM TD a rDaTS(mtsytamhwn.saanuluy13"7111simetc.)
4.Date Wdl(s)Completed: 10'' j c 3 Well ID# S m 30 ft i
Sa.Well Lucatiom 3 a It 3 tt. Leist re Iw«t re «„✓>
` eiljNI i5 �4 (< j ilki 3S' f G S if" '1'' -lGr /p,c L 41lf‹.-
Facaly/OwaecName Facilitym#(d k) /JP<It' 1°V-IL eDiQ/tV..-LJI v yV
7(,o ?ft ALE7 6(axle. Ag_en_De.A., r1l... 2a3i.t /OS$ 1/5' Q .Ts,-t • &-, r.-'t 7- 7.7 . (Ti':
Physical Address. y.andZ ft. ft. I i a a.:•' .i' �t A+
rvt6O2*c a/0562._*1 Zr"REMARES
OCT 2 7 2023
Cry Parcel lde ionNo_(PIN) --
�ni
Sb.Latitude and longitadein degreeeshninute�stseooudsordedmal degrees: I. ;i :: "'_: Uri'
(dwellEdd.ene!Mang is=Mama) = cation: 3r/2`-A- 3 n 8-c ,
, , `f, ,t N r7g6Z4 Z� 1/ - W API 12 A � r34r1 3
6.Is(are)tIewelks):1 fera>s>ient or °Temporary me of c1t,ti d WI Caat<setar Date
Bysigrengthisforn.I barb ymhfyihartheueu(0was(were)co.uLradrdinaceenia eelrBh
7.Is this a repair to as ezistmgwell: °Yes or elDTtr.- ISA NCAC 02C.0100 orI5ANCAC 02C.0200 Weil Cmutrued=Standards cod that c copy
. filth;isa main fiQ out brawn velI coagulable hforma6en and explain thenatrmeefthe aftldsrmrd/msbeaproridedtotheweiawner-
repairtotder32lraatarls section Gran the baelcofthisform 73 Site&nom or additional well detalr
)1.For GeoprebelDPT or Closed-Loop Geothermal Wells having the sans You may use the back of this page to provide additional well eoachucfiou info
conshankn,only 1 GW-1 is needed. Indicate TOTALNUMBERofwells (add See Over in Remo&Box):Tourney also attach ada onal pages ifnecessary.
led _ 24_SUBMITTAL IIVSIRUCII
dul ONS
9.Total well depth below land surface: /d i Up L
For multiple wells listaidepthsraking(eaoatp/e-3@200'and20100� SabmllihisGW-1wIthln30daysoYnd2eampldlonper heloIIawing:
la Static water level below to doming: 7tta.For All Welk` Original Ilomn to Division of Water Resources (DWR),
riveterleveltsabmae &use p�+ ° ) won Processing Unit,16I 7 MSC,Raleigh,NC 27699-1617
11 Borehole diameter_ 9 (to.) 241.For Injection Wells:Copy to DWR Undergmand Injection Control(IUC)
Pmgram,1636MSC,Raleigb,NC 27699-1G36
12.Well oorutradion atdhod: 1'l t f i 1gc.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
CA-sager.tunny.cable,direct peek`tc) cusmty environmental health department ofthe county where mstl►ed
FOR WATER SUPPLY WELkS ONLY: _ `d ��ar P✓� 2Ad. Water Wells d ;over 104100 GPD:Copy toDWR,CCPCUA
13a.Yield(gpm)) �p j, Method oftest p Li 419 _ 0gram'16111 Raleigh,NC27699-1611
13b.Disinfection type: fl1° Amount: Y Y. lh LA -
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Fenn GW-I North Casoima Department ofEmiaommnal QaaTRy..Division ot'WaterE somas Revised 6 6-2018