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GW1--07133_Well Construction - GW1_20231101
WELL CONST1aUCTIoN RECORD (GW-11 For Internal Use Only: 1.We Contractor Information: A .ZQIiE3>=.y :$''' "� " z14,:W FROM T I DESCRIPTION I r Well tra tor Name ■'igillia : s`=i-I"wells ARZ `iER t if`a:'�lical'Ig.��-se4 F=Fr.�16�::•±. ':e15ioIIT tlX.: G fosififai ' TffiCKNESS M Well Contactor CertificationNu INCROM r TO mAME' in'lI 6118 . • • -• Morgan Well&Pump, -"` ;16:I1QIQER.Cr9SIL1Ci;OR�INCT :eotli`eimapclose�_lo 1111111151111111111 DIAMETER imilimilim.RIAL Company.WllCons . FROM TO 2,Well Construction Permit#: State,Variance,etc.) applicable well construction permits(r a Tn ounty, ®® 5..., . . aw"' i ..''� List all ;. :.°>• ':.. •. 1111.161111111111111111111111111 -morfUCENE S 4�"•jili"s�.�-r-- 3.Well Use(check well use): • >17t:$CREEhL.=�'-r--• "'-"/mom iimarr DIAMETER`"sx.o� - Water Supply Well: �j Municipalt'Public II Agricultural L�j Water Supply(single) <,_n4;: y^ .;a •Geothermal(comer g/Cooling Supply) *Residential W PP -.: - �„: ."rr, •_s:... •;,1::_,:=:,:. �.- �-�- - =�i'"•:-�'" TROD&AMOUNT IIIIIIMINIIIMIIIIIIIII DResidential Water Supply•(shazed) '1S?'GRO71T'= .':C=' EMPLACEMENTME i lrri:triaUCommercial FROM TO 0 it. 2p ft Non-Water Supply Well: *Monitoring onitoring ® ;; N ems,: ... Injection Well: EMPLACE1vIENTMETa' �GroundwaterRemediation r�.S�(�,1r�;I'i.pAGK rf:�,7ira"T'le .•;,-: .,.��•.�..�-�- *Aquifer Recharge a FRo® T® �,SalinityBarrier oD �tAquifer5tomgeandRecovery �StormwatetDrainage •iExperi ExTeperimental 1111111111116111111011111111111111111111 ._. ,€.;`.. :=t 1 ©1Tracerence Control size,etc. Experimental Technology G'attach sESCR naLs7N col r,hardness, ard ess,soillr ck'I.e,I.•'k i GZ;O; 20DRII�f1!1 D�CRIPTION color,hardness,soillroek I.e,� ' FROM *Geothermal(Closed Loop) �ITracer To � • Geothermal(H eatin Cooling Return) **Other(explain under#21 Remarks) b ft I:) ID# 4.Date Well(s)Completed: Well ��" �� 5a.Well Location: - ' �±w wi_�+ VOCAL Facility-'(if applicable) Mill Fan' caner a 11113® s3: Address,City,and Zip n 2r _ �;'?;f:`- _* PhysicalA IIIIIIIIIIIEMIIIIMIIIIIIIIIIIIIIIIIIIIIIII �'_,��/ 1 _'1-rrr.r ■ 1 Parcel ldentificationNo.(PIN) 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: 22.0 cation: A n 1/ t (if well field one lot/long is sufficient) I V l 1 V - 20 N�h �� W 11:14a423 . Sigoa f 'fied Well Contractor �- p� era or rn,I hereby certhfy that the welt(s)°'wasl(ilereLca t ted in accordance 6.Is(are)thewell(s)kPermanent or °T p Byso mg j� with ISAIJCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a well: ��r� or �"`o copy of this record has been provided tothe well owner. 7.Is this a repair to an well explain the nature of the If this is a repair,fill out known well construction information and 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well repair under r remarks section or on the back of this farm• also,attach additional pages if necessary. Geothermal Wells having the same construction details. You may 8.For Dion,only 1 GT or Closed-Loop ofwells construction,only 1 GW-1 is needed. Indicate TOTAL NUMBERSUBMITTAL INSTRUCTIONS drilled., of completion of well (ft.) 24a.Forte s: Submit this form within 30 days P 9.Total well depth below land surface:�I 00'and 2@I00) construction to the following: For multiple wells list all depths if difj (ft.) -��11L4lJDivision of Water Resources,Information CP2769951617 ing m� 1617 Mail Service,Center,Raleigh, If Static water level below use top of casing: the form to the address in 24a Ifwater level is above casing "+' 6 (�) 24b.For]nie�n RteIls° In addition to sending 11.Borehole diameter: above,also submit one.copy of this form within 30 days of completion of well rotary • construction to the following: l • 12,Well construction method: Injection Control Program, (i.e.auger,rotary,cable,direct push,etc.) Division of Water Resources,i Underground 1636 Mail Service)Center,Raleigh,NC 27699-1636 the fora)to FOR WATER SUPPLYWELLS ONLY: P of this form within 30 days of Method of test: air pressure 24c.For Water Su 1 &Injection Wells: In addition to sending 13a.Yield(gpm) the address(es) above, also submit one copy ` completion of well construction to the county health department of the county granulated chlorine Amount: V'1 M. where constructed. • 13b.Disinfection type: Revised 2-22-2016 North Carolina Department of Environmental Quality-Division of Water Resourlces ?o:. GW-1