GW1--00512_Well Construction - GW1_20240118

WELL CONSTRUCTION RECORD(GW-I) For l UseOnly_ .
is Well Contractorinfonnation: ` • .
Y✓gitile 15 V.iri-i f (Rr".(___ .L-44 `. , Pt WATER ZONIM
marciimnow
WrIICoatraaorName A ,�aor m
C7737 'z —A - 3, r'W ao it- ----111 1L tItN/ .aliAtiL - -
tz n
WW1 Ontifecfsnaxumber 1 -
d4z/NZ b( ff a�w-t-i-d y FROM s CASING cr� .��aR ble)S9
1501 TO mAMtsa 1ffiI a •
a ft. t
Company Name + 16.1 �SRCASII�IDOR?1UWNDf(eotermald Oop)
2.Wdl Consteuefion Permits 414 s /1 "134I- • FROM I To DIAew= mmNEas j tiATIZiM.
Lidallapplfea6fetcffaonsliarhbnporrt is(r a r 1C County.Staitt Vwim=eta) •ti/ IL 53 IL 171" rm Se k-y'' /3%
--- ---3:WdlUse(ehrekweIImex - ' --_..5._,_- -- - - .--C7f --lt- -foa -- tZ _+Ve_ wis ,ie,h4/4-- -:p✓�- - - -- --- -
Water Supply Welk - . . 17.SCREEN
PROM TO DIABIRIZR SLOTS= THICKNESS MATRRIAL
phg(ieultinal OMimicipaYPnblic .5'73 IL (IL ill
i'.in. 46 343'j S
rJGcOthennel(Heating/Cooling amply) t]Resideatial Water Supply((single) $ _
Dlndustiial/Comm�ial al tesidetdi Water Sapply(shared)) la(*BOOT 1
nlmgation DWalls>IO0;909 GPD FROM 1n !MENIAL EIM1Acl rraEIRoD&APIONNI,
Non-wake Sup Wdk / d/f;0 ju4 v(.4G
oMomitoiing 011ecormy it. IL _ .
Injetlkn Well:
1<
°AquiferRedone t3Gramdwateritemedigaoa
19.SANiD/GIIAVEL PACK(iiaPpttaa )
LAgwJx Storage and Recovery DSalmltyBama FROM 1O MATBBML IMMACEMERTMEIROD
OAqu f rTest DSoolmwatcrDrainags a2/ it 4'4) 8 4I V'/tY i2q./P/paidt�
�manal Tc dmology OSnbsidence Cooled ft.
! t U
17Geotelmal(Closed Loop) Mager 20.DRILLINGLOG latbdiaisRfinnalshedsffneoemrp) • .
OGeatIeemal(lleeting/CoolingRdmm) Domer(explain rmdecd21 Rmi nds) FROM 10 DE raoAcewr.rsnsoegssaAoaez1pe0at. ay
a g as i ap_.S6ist + d _-e574iki0
4 Date Well(s)Completed: t --1- ZS WellID9 ,04. IL IL ithid,e da/14 S«rF-.0—m IX
It 6y �!¢,y/a / - -_ Sn.Weil Lomtiom_ -_ - --
i)k1efe L�ewief LL Lilt a l't :. 4g ft. S e-
Fonliry/OwnerNema IDit(iif )
ag-•?.-5-1QC-7.Ai 2.# 66 teS/C9 S Ak 2_72442_ ft. • ft. ir-;',';----C..;1,::: \I iF I) i
PhysicalAddtess,Cdy,and Zip >. $ .9"i`a LOB
rY1 2e - 9k �9i 21.E r, .
County - PatoelIdeatifieatimNu(Pt1d) - ;n;;.- :..:?. -.':•- _-a:-~ U n'.:
56.Latitude and lougitudein degrees/minntes(seaonds or decimal degrees: E`'C:i
0E440
' ofCat�edWenCa �3.5 -1'7 ' 3..3• -Neiev 31 /. 3 slt. .. _ i -zws ,v/
6.Is(aee) eWd(s)_; emanmt or OTcmporary
or Dace
Bgsift ngpdsfiunlhosbycaatff'tkptthewsd!(WJvos(wue)amtz6adadmoccoadoeewith
7.Isthls a repair to an edstingmeth . . Oyes or s ,o ISANOIC 02C.0100or1S4NC4C 02C.0200WOUCaaOIZctiein Sraidrads and that ac py
. gilds isarrptifr,Jill out blown ire I constmcilan&fmmatiot and=plain the iwinreofthe aJti>arerotdlraababipmw[hdmOwllowner_ ..
Impair rmder02l.remarlsmeatiwi Gran the baetoffthisfoan 2 tde diagramor addifional Welldetaili .
$.For Geop•robeiDPT or Closed-Loop Geothermal Wells having the same You magalise thc.tuck of tins page.to Provide additional wdl oons1s union info
construction,only 1 GW-I is needed.Indicate TOTALNUMBERofwells (add�OVis'm w'tu Box).'Marrow also attachaddkional pages ifnecessary_
dulled: ?A.SUBMTiTALII�TRUCIT._. . i a ONS'.-
. _ ..- . .
9 Totalwea depth below tend smfaoc Lb. (th) Salina/hits GW i within 30 ofsdl n the
Fo�rintitiple wear list alldepths ifdi,(faint(�ple-34Z00'ard22@l00) .
?Aa.For An Wells"Oriel`f in Division of Wder,;Resources,(DWR),
10.Static level below top ofcosing�:. g /�1 (11) Information rtooessingliniZ 1617 MSC,Raleigh,NC 276994617 .
If,+wterlesel tsabonawing use/+�-, t f
1L Borehole dmmeter ` `�/ •(in) 2Ab.For Iniation Welt .Copy to DWR Ihelergrooml Injection Conitol(lUC)
- Progcam,1636 MSC,.Raleig6l NC27699-1636. '
Lt Well eonshvefio melba& 411Lt 11 Zlc.For Water supply and Oien-LoupGeothainalReimnWells:Copy torile
f''`.n04(Q*'• . ) comity rAvit®mentalhealthd oftbe
canmp where installed
FOR WATER SUFFIX WELlS'OM.Y:
24d.For Water Wells aver ion GPDs Copy to DWR,CCPCUA
Yield�) Method 'Permit hegtem,1611E Ra1�gf,NC27699-1611
136.Diesinta�ion typm=WI// We Amount l Z
FomOW-1 Notth CarolinaDeparbnentofEnvinnannualQ®Tny-MinionofWaterBesvaaces Revised 6.6-2018