GW1--07196_Well Construction - GW1_20231108

NULL CONSTRUCTION CO _ (GW--11 For Internal Use O I .+-
1-Well Con Informs'on: ' - ) - •1
Well Coatraetor aide . '14•WATER ZONtIS IH 1 ,
.\ 17tOM TO i I DSt�a1iON
,t `5 r1.7,A: AD _
35.OUTEA CASIIrG(for�iulp oted�rells OA Ln OLR�[a
moat zO f r Grdwri
°Coon li INNER I D �aQass Mwamaaa
us4 it'ction Permit#: Q Z l *ROM GSIIVG OR TUBIIiG(geothermal dol-Iwn)
I1rr i. all appl/aabla urll eav+ro�realoa poayts A�[FG� :StotS Y i maser= • 'martass MATERIAL
_-S 114. W.. ill. Th I ec:. p ii..;- : ' !.
`Weu Use(c6edcrreu use): qq
'WaterSunnlyWelk I• II - . .
�7.SCt2E$M •
;OAgiicultural•:-':' O . - snow TO nrenurazt` SLOistZte Mtmicipal/pub]k ft 'r'mt tl�man..
' °Geothermal • Supply) R- '. -.
1 (Heating/Cooling Siamtiai Water Supply( )
' °Monitoring OReidSea tialWite r Supply(abed)
•
W !iOraigatiofi °wd1 >1000GPDFuIR GROUT Ki•r OM TO
• mPLACRA ITM TEIOD&MAOurrNon-WiterSuppIyWe1L . . U R 2.11 ft' II �:Lr •:. .
• Injection Well:, . . [ .til .
• ft' - oi=-1lau' (ivy,
°AquiferRec}targe ., . OGrotmdwater&mediation I _ -
OAquife rStozageandRecovery. DSa1intyBeuriar • 19.SAND/GRA77ELPACKrd®aolieallel •
OAquif Test OStormwater m •�L nalae�arriarso))
• OFxpe*mental Technology , ,OSubsidmce Control ' t--; - R io is
• ft
OGeothesnoal(Closed Loop) OTtacer g 1�,
20.DRILLINGLOG(atteel iaditioaalsteelsifaesessan)
.OGeetheamal(IIeating/CooliniRetom) °Other(arplam under#21Remaa) iF•1e43
ee •ro •Im tsaarnort(War,bantam,antes&type.grain the.eta)
4.Date Well(s)Completed: 1 l—r+.Z 3.. wen ID# i< :R, fl {� , •
5a.Well Location: ft IF '' '_1,
ft IF 1 r .£ ,
T'S,rii. Kn.1 h .3-LA i 1d-tl5. R 18 �1 k..•' iF,
• Finlay/Ormert am•. ,, ,, acili r iDd Cifapphahte) . '' se ft, 10 1. 0 V. 1') L(123`.' .
:'RGl riA. k-+ Qll ?- --& ` i L . ; . -:ft. - . - fe 1I- ' 1.r1;C T.417r1 z,
. ,P6yaa'IL�+d3letR Cali.au Zip g u `4;;+ - y :a
" U'A L.1/L� TLBEMAR)i^5! I�.i
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees: '• In ''
• (*Ewell field,one lat/long is sufficient)
6.Is(are)the well(s): tlper nanent or OTemporary I f G Sienaoue of -...-n' Date
By'slttht this one. hirsby that theirsllkPwargi el contouctedisaooudaivarud
7.Is this a repair to an existing well: OYes ,or PI . .• 1SAIYCte o2C.0100 w•7 o2C.0200 Well Coutruatoa Simian's o d that a eopy
IOUs is arspoA;fill aid hums lea Consarzattonkforwat/onasfeaplainth marts tithe althtrncadhae"as ihs Wen°II"'
, 'npatriodsra2lraemis straw oron the backed:!slaws.
23.Site diagram or addrhtial well details:
8.For Geoprobe%DPT or Closed-Loop Geothermal Wells baying tie same You rmay use Me plc of tiiin page to provide additional well construction*n£o
onnsru tion.onlyIGWlisneeded. hutir•at,1TOTAL NUMBER ofwells (arddlesCII,'inRad• ads )-YoumaYalsoanal%additionalPageseneressa:p.
24.SUBMITTAL INSTR enoNS •
. - 9.Tote!well depth below land surface:` 2•
Foran�G/pk srellr'//st alldepths/jdlffaart(esanpuo-3(11j200'and2®!00) (f t) Submit this GW:1 within days of well completion per the following:
•
10-Static . 'i water level below top of using G D 24a-For All wells: orl font , Division of Water 617 ,ces (DwRI
"water dls above ebslnyute"+" (ft.') InfomoationProcessing 617MSC,Raleig6,NC2T699-1617
71 1
1L Borehole diameter. �� {m•) 24b.For Infection wells: y to D• 994 Underground rnjccti. Control(IUC)
L /; Propam,1636Cr Ralei NC 27699-1636
12.Welt wnshvetioa method: U'[a /�• .
(i.e•auk tomy:able,dneetp ) ..•. . 24c.For Water Supply an oen-Loon Geothermal Return Wells:Copy to the. . •
, ` county emvironmeatalhealti eparbaent of the county what installed
FOR WATER SUPPLY WELLS ONLY: f i
_ .. _ 24d.For Water Wells rode ' over 100 000 GPD: to D CCPCUA
13a-Yie1d(gpm) �� (' . �• 1 Method of test; ` ,a.- •
Pamrt Progiam,1611 MSC, gh;NC 2T699-1611 '
•
13b.Disinfection type _ . lk 1 14 :Arno"nub g -`•'(
Foam GVI/:1 ' ' f ;,
North Catol lei Deput:emsofEavuonmmLl Quality-Divipc4ofWater . Revised6+•6-2018
., it