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Home My WebLink AboutGW1--07652_Well Construction - GW1_20231204 . . . 11.1111711011 WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: • .1 W ny'ontractor Information: MTEIt)ZOPIESS s I ".au •x::z.a . w l� �f;4�... 't��..`_`'� a��ii �'d�r,��N;�1_�> 'a;.�,,�a•.�i;�"��•;��z FROM TO DESCRIPTION Well Con Name : c ,5 ft ` ft. to n 34 a•2-- ft. ft NC Well Contractor Certification Number • y '-,l ""' •s Y l 1 r A �LS;�O,IIJi�ER�ASIL�TGY(far-�mu1)l:caae3;,Pv �OR"mYbR;(�P licab"le)�..�a` "��=�i+ ' Morgan Well•&Pump, INC .FROM TO DIAMETER THICKNESS MATERIAL • 1 ft- 10 ft 61/8 I in' sd21 pvc Company Name 10 ft---- s..-.r:�_ isy �� ak5l� �-�6��I�ERCsASPIGQI� Uj3I��EReothei rma"�E'c5opet�,lapp; �'.,.;a�s .� mom. TO DIAMETER THICKNESS MATERIAL, • 2.Well Construction Permit#: 'ft. ft. in. List all applicable well construction (i.e.UIC,County,State,Variance,etc.) • ft. ft. in. 3:Well Use(check well use):. 'SilOS'.`' I'..''1'.I W"... ;�x9s---„�: y r,�z .,� '�'1- :.:s:.syr'a Water Supply Well: FROM TO • ' bIAMETER SLOT SIZE •THICKNESS MATERIAL *Agricultural olqunicipal/Public ft. .ft. • in. J Geothermal(Heating/Cooling Supply) *Residential Water Supply(single) ft ft in. • *iIndustrial/Commercial EIResidential Water Supply(shared) pi,:5rimom• r, � E-4 !tai�t„ . ---i I-E-17a FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: • o ft. 20 ft' bentonite poured *Monitoring . DRecovery .. ft. ft. Injection Well: ft • SI Aquifer Recharge - DGroundwaterRemediation g14TS rGIf& ' (i*. apP-liaiilejrw''? ; we y "- --, *Aquifer Storage and Recovery 0 Salinity Barrier _FROM TO MATERL4,L. EMPLACEMENT METHOD gi Aquifer Test QIJ StormwaterDrainage ft ft. • b Experimental Technology. ®I Subsidence Control . ft ft. �rr�.��x�as�il •:Geothermal(Closed Loop) ' DTracer __ Grant'i'_ch'Z`ad3i'tiorixlzAfieetr t necesiary�m`� �rK- FROM TO DES ON(calor,hardness,sail/rock type,grain size,eta) 1 Geothermal(Heating/Cooling Return) lJ Other(explain under#21 Remarks) C� ft l ft �, 4.Date Well(s)Completed: Well ID# • 15 ft ' ft k-Y h �,r r �� ft. LC" C ft. � W� �/k/.L a.WellLoLLcation: 1 ,,,� • W�1 I 1_ Tc7 � 1✓ ' GS ft. 3`6S (� Q YGI.�r..6'4C, ' FacilityMt/ if applicable) it. ft u Facility/ erName �/(��pp 1�) . '� It k %' vAs'r` 'IW 32 ft. ft. Physical/ri Address,/�Clity,and Zip 461 County Parcel IdentificationNo.(PIN) ,�sr 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: DEC (if well field,one ellatt/long is sufficient) Qh 22.C cation: J r 202 3 .' ' itb.UP t4)53 6.Is(are)the well(s) Permanent Permanent or Temporary Si o rtified Well Contractor �v��,'3D1aie By ing s form,I hereby cert:Jy that the well(s)was'(were)constructed in accordance 7.Is this a repair to an existing well: DYes or DNo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a If this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner. repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. .- drilled:' SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 3�C J (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths if different(example-3@200'and 2@I00) construction to the following. 10.Static water'level below top of casing: t 115 (ft.) Division of Water Resources,Information Processing Unit, If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 • (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a rotary above,also submit one copy of this form within 30 days of completion of well 12.Well construction-method: construction to the following: I (i.e.auger,rotary,cable,direct push,etc.) • Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS C:)WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 ' Method of test: air pressure 24c.For Water Supply&Injection Wells: In addition to sending the form to 13a.Yield(gpm) the address(es) above, also submi. one copy of this form within 30 days of 13b.Disinfection type: granulated chlorine Amount: •\b aZ completion of well construction to the county health department of the county where constructed. Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources 1 Revised 2-22-2016