GW1--00161_Well Construction - GW1_20231229

•
•
•
'9VEI,I,CONSTRUCTION RECO , tGW—.1)
For Internal Use Only
••
1.Well etorinformation:i 4 j •
_.
ao •
Well CI '� • • •14.WATER ZONES I I , • ,
PROM
1 I TO ➢DLSt1Rm'1ION ,
�.5R7 -!-1 I50a' 'too iI
' NC Well Coatraetor Cc:bleedo=Nmabea• •n••
• IS.OUTER CASING(for mub4.eaNed wells OR LINER(ifap noble)• PROM TO . tDIAMCrRR T1ffCI0VLSS MATEWI,
•
Compaa7,Name y y ��
2.well Construction Permit#: • Paul_ a Ua O c 7 16' ER CASING OR TUBING(aeotbermal doled-loop)
Ltrt all apppmbk well wnorurl/on L• PROM TO • ADIA1fSrsR t� •
pandit(1e WC Cotoiry,Slack,Varramrg etc) ft. ft':Ili in
3.Well IIse.(eheckwell use): • i< ill in.
Water Supply Well: V.SCREEN
•
PROMI.TO N N
•,Eia ncu1tural 'OMunic - sLorslza THICKNESS•
°Geothermal rpaUPublic • D,Y MATERIAL
(Heating/Cooling Supply) °Residential Water Supply(single) M .
°IndustriaI/Cammercial °Resideatial'WaterS R I N .aa'
°Irrigatiolu uPP11'(s�) le.GROUT 9 N
OWells>100,000 GPD ' PROM TO O,Et Non-Water Supply well; a Y T r n+Qr.►cn+uerrM��D AMOUNT
'• Monitoring °RecoveryI �t M
(
- -• Injection well: ' R tc' I Y' n)Y f't
OAquiferRecIarge dwatrrRemediation 1
tt: Y 11 •
rah Q' 14
k,�
OGroRm
• °Aquifer Storage and Recovery • O8 19.SAND/GRAVEL PACKfdleppliceble) •
alnityBarrier • PROM TO Mwristr r.°Aquifer Test OStolmwaterD!eurage ft. nuuL�►c�rrMsrsoD
°Experimental Technology • °Subsidence Control .
• ft.. Y;
• °Creotheamal(Closed Loop) °TraCer '20.DRILLING LOG(attach id'ditioaal sbeeb;Tau:essaay)
. ❑Geothermal(Reating/Coo)iagRehrm) a Other(explain Under#21 Remarks) PROM TO • 11, .D rrON{abr,leulaeo,a.atnek Ore:.Vain size.de./
4.Date Well(s)Completed: l2-iu .i3 I Y''
Well 1Dt/ n • •" I , i-
sa�.1.W�e�llloeation : fl
P T1'6 rrL v G R , i CJ ,, 1
• Facility`/OrvuerNsme �'4'4 C u .- t
•
Fatality IDS(ifappliable) • , ft. . , ft• .I I , /ii r
Q eaci•�t CAA A r , Pe-e v.e.5 R'd . • �'rt: it. IIPLysial Address.City,and Tapft. -.s r
2L REMARKS! N I •k`
County -
PaeclldentifiationNo.
c�� • 111 . nor 9, p 202'3 •.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees: •
.i
(ifwenfield.onelatI1oagissu�cient) I Yr
•
L' .'f .{ ' U , lace n;c�, . :: r:�:;,� ;, ;:,,
•
6.Is(are)the well(s):APermanent• or OTemporary ' •. Si ,.
df Co ry�,r
tZ- Z z—Z ,
' i' ' ' '
7.Istirisarepairtoanexistingwel: °Yes or e d Birfrendth form.Ihaebycay/ rAorhewell(r)war liven)muauaxrdIne '
o•. .44, IClCO2C;01Meq.S..YNCiI 02C.0200Well �'�"C1��
.- •- --IfthisIrarapa/r,f:llout balm wel1 warn-action bformation tanouaxofthe .--ofthisre-ord/aubeef:provided/a circa owner. CVtuovaf• Stadardrandthatocopy
repo1r wide,121 remarkssection oron the bad frbtrform -
23.Site diagram or addifio ell details: •
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells baying the same , You may use the back dulls age to provide additional well construction info
• construction,only 1 GW I is needed. Indicate.TOTAL NUMBER of wells (add'See Ova'is Remarks Bo You may also attach additional pages ifnecessary." .
dr➢lled:
▪ 24.S1B3M1'1TAL INSTRUCTIONS •
9.Tofal well depth below land surface: •L7-1'L 6 •ForemigrewetsArtafldepthslfdlfj'eienl(example-3(a 00'and44100� (it) �i
•77 Submit this GW-1 within 30 ys of well completion per the following: .
10.Static water level below top of easing-. d ;▪' (f`, 24a. For MI Wells:•Ori • turns to Division of Water'Resources (DWR), -
iJwaterkvel/saboveear/nepra+'I - . Information 7MS Ralei' • f C, gh,NC27699-1617.
11:Borehole diameter. lino) • • • 24b.For Injection Wells: ,to DWR,U
Program, MSC,Raleigh, �t�ound Injection'Control(1(IC)
12.Welk construction method: I o �j 27699-1636
(i.e.auger.row cable,��P ) 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the •
county cnvironmeatal health d'` t of the county where installed
• FOR WATER SUPPLY WELLS ONLY: I .
'3 • 24d For Water Wells prodd ig oiei •100,000 GP•D:Co to D 13a.Yield(gpm) Method of tat: • P 08t�,1611 MSC,Ral'igb,NC 27699-1611 ��`�.- •
13b.Disinfection type: H .'
Amonnti Gt/
•Form GW 1 , . ;
Medi Carotin;DepiumeatofFavimmaj Quality-Division ofWaterRea s n��... ..._