GW1--00094_Well Construction - GW1_20231228

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FELL CONSTRII , _
Cl'I�N RE._ �V 1
L Well nttacto•Info ForlatetnalUseOnlii•
\ 'Wen Ceat aetcrldmm •
c • �� 1�.WATEItZONlS • IN I L '
• 3 . 3 PROM ' TO I rozscaanON
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NC'PM' - .Ce,eoaxmsbes • ft. r�
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. 15 s
OUT R CASING fir lrti-e:�ed LINER d
. OR • Viable •
o � -� 'PROM TO . O miAMi7�t i,!`t' '= a�� MA7IItiAL
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Coma,y N
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Q 1t4•1NNER CASING OR - thermal dated-lei
Z-Well Construction Permit t4: +2
W Use •
iisfailepplicablewraeauw cnpas,ae.WC COinly.Star Y eta) mil®• lmtA �.: a iwazaub►L
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3 (check well ) ft"• ppryry .� C A t,Y!i
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WaterSuppywell: •
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• °AgriPlibl al 7.SCRE$11 mBtl ' •
ipaUPublic ` - PROM TO D 4,11�r= SLOT SIZE T�MOM•DGe th•maj�g/Coolmg Supply) - eotial Water Supply.(single). • � - n. ttaTrQtW
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° .o • Water Supply(Sbar,� is.GROtTl
Non-Water Supply Well: n•
• DWells>100 000 GA) HI ,
Ibrkrans►. �1 ACINDIT.e . .D&AMOONr
' Injection:yell • O 7—•--ry- '•
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°AgwferRecharge, 'OGtouadwaterRemedi• ation n. • N.
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°AgaiferSto> audRecovtxY OSalaptyBanet •
19.SAND/GRLVZLPACBCdlimplicablel '
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°Aquifer Test °StomiwaterDtainage , PROM TOft �IIu
UgqTiAtAI. old rrt�taoa
°Eperimental Technology °Subsidence Contra. '
°fieotheamal(Closed Loop) 0Tracer tt !t �O�
OGeothe:mal 20.DRILLING LOG(attests ii'�liheaal sheeb if mecum) •
eating,/Coolin Redlm)' DOther( lain tmder#21Remadre) PROM ' TO IT CRtt'I1ONIral..huias...;y,.�'Inc..
4.Date Well(s)Completed: l 2._i•9-Z3 Well LD#_ • ft • L I �i; par.ao;ecc)
5 Well Loation: fU�y�' f
c,` it p,u! ``l
FawlrtyIDA�Cf4+PGah1a)L� � �W.•. .. Di, C ��0, ^�`
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Physical ALis, and""4 � / - - �' �, ���Lif :.''i�.ri'l.
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Coamty '-- - ZL RE)<YARI{5j i '. ,
Paool Na(PIN) •
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field.one Ieidoab is=tided)
6 7 TS .22.Certifies'•on; - I?' ;
i_ ILL
6 Is(are)the well(s):ikermanent or DTemporarj 3 2/0 ' Signalize of• I ' Dab^Z 'Z
• itivellcatw, � • Date 3•
7.Is this a repair to an existing well: . °Yes or
I• SANdial, C OJODborbyeo9q 02C.0200 J�nahauJskis&�dmi -
I f L-Ira i�alr,f:1 osd know we II oSt it tec ghat h iPiPiw de well o 00 Aell Cpn
- auoardanrswtty .
mnrnvaron b9ratsiatloir mid the,auiou Vac aftbls nas,dbac bic� oa Swdasds and that a copy'repair wider DI remark:sectinoranthebackofAdrfonw p►iwldedto� ewepbwnQ
23-Site diagram or additio r ell details:
• 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the lame • You may use the back of.�,•
won,only 1 GW 1 i,needed.Indicate TOTAL NO►�E&of wells • tadd'Sce Ovet w Remarks B ouO apy also dit addi wndl peges i n j
may also attach additional ifnocessmy-
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9.Total well depth lielowland smfaee: .a20 .SQBMIIT;+�LLNSTRIIC�ONS
ArmuhrlewctirUrral%drth"rdrer fxawk-g02�'aid2(�.(003 (�) Submit thisGW-1within30
• ��sof weD eomplgtion per the following:. • •
lO.Sgtiewaterlevel i belotr tti of
11,ro/erleverreoboreanrlry;a#e+ `fig' O ( ) 7nfoimatloaP�ncem au to Divisim of Water Resou[Ces.(DWR)�
/w 8 1 7 MSC,Raleigb,NC27699-1617
1L Borehole diameter. (o I ?�b�For Intectioa.Well,-
{so • u to DWR.Underground injection Control(- S . .
12.Welk eonstraetioa method:- •
Program,1636 MSC,Raleigh, :27699`1636
(�a augetmdry.cable,direct L�67a +�'7 Cl.->
P' et) 24e.For Water So and 0 too Geoth ., t. --- •.
!Aunty erniy Return Wells:Copytothe
FOR WATER SOPPLY'4VELLS ONLY: • • • '• th •,ll 1 ofthe RAaaaty wh' auhdled
/� �� 24d.For Water Wells roddan over 100 000 GPD:Copy to DWR,CCPCUA .
132-Yield(rpm) S Method of test: (.�C.e.4- ?mid• gaam;1611 MS
• . 1gb,NC 27699-1611 -
mnfectioa type
Form OW-1 North Cand
illiii:ParimentofFaraooaraldQoLry-DivisionofWakrRes D_,.."