GW1--00062_Well Construction - GW1_20231218

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WELL;CONSI,'R T . ON RECORD(GWo>i1 - Print.. "r: : .
For Internal Use t7nly: • . ;: . .
: . - 1:Well.Contractor><nlbrmaHoa: ..
David Belcher . . ' •
wall CoatdotoiName :. .. ' - _
FROM TO DESCRIPTION.' -
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.NCwll onNi e .: " " ". l9O & :Icd: !•''' 5(:dP_Ai_(r�rar►ktr ..• •• • • __ _. e 1S.OUTERCABINi(formNfled ve>b)ORLIIIER ManAqua:Dr111,Inc. .. ,•, ROM DIAfETER _ r�cmuess s�LCbmpnyNaie � I � � I 1
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2.Wdl Coasleucflon Permit di A.. '�4. 1
Lidt trell lcable welt nl.e ngei ponlea(de UIC" ��
" �MINNERCASIIVG G(
' Count,4*VaNanc� D - _.
3.W01 Up(checkvfell use): .• . '•'
Weber Snpply"p'en :
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paUPubh ". _
•Qe thermal Cool su
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dill* llle)- '
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SIDS- •
TiIIQnYSBg NfA TERIAb : • ' ,
Commemlal. . " . , . ._
. . _ CIR410) 0watersuiply( )•' '.'
•Iei_xtl�:. •Non Water supply Wells • " :.i...:. .- •. . FROM •To. -•-_ -MATaaW.. EMFLACEMiotTMerROD&AMomrr'
: !Monitorloi: • • • Ir Recovery , .. : : • "n; 3.- :: ( k)l?• .. i••--'' ' • •f d }(I "
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ReOill a•" '•-•. • . ":• •. tiQ dwata,ltemediation".: •
*'• ' ` Storage and Recovery_" • S 39 8A1VD/GRAV7i IACH(Uflnnlie.6le) •• . .
I alinitq Berner" . _ . ••� �� ,_i.TEBt : . . ' � _. ' •FIIOM'r ?O.' .. " MATLNiAir.
• tornnwaterDrOicie - •
fG rsiBT80D.
i9 , ," , a, . .TBy •• •" SubsidenceCantirol : " .
*c r�nal.(Closed Laois) T •
Geothermal r :„ .: •. . • . • '.
Coo :Return �'O 1� 1lidANG O( Ce .ud.heehRmceas,ry) • : ."
4:DateWeu s Co Wellfl p : : 77: free
3121 Raj lei uunw..onrmrYwaa.r.�.>za�).
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6L Well Lceatton: • �
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Faallt�y- • _
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1'enfo1 rdeotiflcgdon No.(P •sb.>wnsmdaa;,atoa ;>elaa" u i I:::b. S. '� :
51i.i field,ono eiiiis/nilpnteg/seconda or detlmal depeeest - • �e
. I q • • 2Z.Cerslticaffon. .. .. ;g r ,�:VEX "
jfio re N : '+if o "1I' %.Q a . " ti'� '
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6,L(are)the well(a) Permanent or �Temporeirq sfs°�ofca�t we� -. ." " _:
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7 b tWe a re. .-- n e:rating well'
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Data-
•By staIngISAII th18 03C 0 110 or ceiSAN•that the:0200) elI on:11'c61i S red In fowlOWii '
•(this7 aivabiAl1aur.luioiv.live(l� will, ISANC**'?!h O(ODoriSA1VCAC01C.Od00WeDConrhvc:":. .•idardsmidlhara"
..relmerunder i�2J reme►� �+'acllgn l4fo�muan and expCalaYhe oatureojthe �pY.�'�*rccmif has:beeaprovldedro Nit well owner. " .
+�lana+'gntebaeoffhbf4irm.. . •.
-. Site dla '.. *di data➢i -'.
.� or addlttenal
B.For" tl�. . • � . .
prube/DPT or Closed-Loop Geothermal WeW having the:sama • ::. •You may'use she back.of tide'Page io pmtnde additional wall site damns or;well,
constnrotion,unly:l aW 1.ie neWed:Indkiit TOTALNUMBER.ofwells: construetioa details:You may also Mach additlonai Pages ifnecessaOr •-
drIiled•• .
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. . 4 Totdlwell • • • • AWN 1V19 ; • • • .." . ." l9tUBM[i'!i" .
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depth below laldrrface•:• .�Pu. •-Fbr'awtaplewel1,Neeogde,.(jdlptrrenj(ersmpJe•3Ip00'and2@1o09 •- . 34a.Fur Al Wells Submit this fnm within 30 days'Of.completi1• -of well " '
.10:Stage water rarer helow top ofpeinge. tl.Q
cHciatotlte fallowm� I
" ,constnh { .
110.St levolls above c l bob*
* mow. • • •-(D) • ' - 'D1v.161on of Water Resources;Information Processleg Unll
•. • nter,:Rilelgb,NC27699;1617
"1L Borehole dicmefer. •6 .
16171VIR17 servicb Ce
�' i •Webs: 1" th
1a.Wep corutrirr tton-metittde •. I(•`. :_ .•. abate,-also submit one'copy of this form 30adays Of compl a of well-:
ti o,aup. .rotary:ca6ln,direeotpusi%�o) onao the fbllocviag; ;
FOR WATER SUPPLY.WELLS ONLYi : - ,
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�DltrlelonofWaterResouices,QTnite und:IojectionControlProgram,. • : . ••
1636 Mai lattice Center,Relelg6,NC 276994636
' , 132:Yield(gpin) ,in • • ' " H+Ietod 4. T ou .24e. f W
of CofCa'l Par Water Sunni,&Inleettap ells; 61 addition Po studio the tbrm to-
13b.Dielafecfloa . • ' ® • • slit dmss(es) obi*,also submit'one"copy of this tb m within 30 of
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ttiype• W Tr'I A to ADtot " 'rod Z. completion of well'constnhctton"ta Itlie county hoofh department of eoumy.
. • .. where consteuoted.
Form(1W-1 No»h Carolina rio4 antofooviionmoOeiamoiti-Divisionofwate Reem*. es t f . n...:... y a ,nn.e.