GW1--01105_Well Construction - GW1_20240216

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• WELL CONSTRUCTION RECORD 1GW I) ► Ilse OAF .
L Well Contractor Informant
,bi/t`/'V-P g kRRtitl+, Rift., D . &, 1a WATER ZONES
WdiComorName sawn ' ID Nee
IL Z3 n /1t Lela -- 73 evA/ree •
a3i2-/4 3%71(4_ fL /1,418.
NC Well Common CauS Number IS MIER CASING(ior s�eeaws�ORLIIIEROf
�[e uJ,ek-� Sa1 tw 'S > TO DlAtm.� > yz
C Nffi ft.
• 16.1NNER CAREW ORTOBING(motel ciao iRooD)
2.Well Conslradion Permit#: t-l-c.jo3 e7 FROM TO DIAMETER THREEwss MATERIAL
L a applicabki*dl alitsfruetiOnponzitsan.WC ComY%State.Varlet=an) y-/ IL /Tq it. 00 ! in. 4.64,tlld file_
3.Wdl Use(cheek well use): /3 ft /3 to IL 44" I Ia. S'4.4- V "VC_
Water Supply Welk • 17.8(3IOIN
_ I mom ' 1D DIA3>El. SATtn� MATERIAL
OCreinhemial ���g imply)- OResia�ial Water Supply(single)ffe /zg. /9 n. -� 3 a� s
DindustriallCommercial dential Water Supply(shared) 18.CRovr
Ohugetion OWells>100,000(WD FROM 10 M&TERUL FAwcscianorrimononaswam
Non-Water Supply Welt - 6 o' A/ //iJeloS , pa 4.t
. - "- _ -
Injeetlon Welt
it. IL
R aa 1 19�.SAI4D AVELPACK(RoppitcaMe)
°Aqw rStrageandRecoveay OSalmdyBama • .PROM TO MATERIAL • ElQIdCEME4r1EDIOD
OAguiferTest OStuwaterDrainage A/ tt 134 IL p _ .
OBspexime tal Technology OSubsidemce Control it ' 0.
OGeothermal(Closed Loop) D Trace r 2a„Me7-•••--,•,GLOG(Minchadfrlional duets Morcemey) -
OGeothennal CootingRemm) °Other(explainnnder021Reinads) tam au D IIOlt(eol�tim�ae.aMhoetgPS�e a eW
d.Dalt We8(s)Completed. I=7-4)1"- W JLID# 3c.1 $ lvd & /44.4 tJd/k 4/2.uw e -
1Zr +ace( -r-�"a� eY�� q4 IL /35F p'i&.- Pile) s o4tie .
f o N :.".. -FaulitylD/(ifttpplicable) , a -. n- s,�„,a, Pt e L rp Leh/
Voila. e'Kc.4'joAus. LN .'ktk -We_ aFr3.1S t'3 /54) 7784 S.Awt3 a. et _ r
Physical Address,e7ay,and z it ft. Ft E ti Va�
hMdD2G 2CTh O y�'Z.- Mr.
MIMEOS
County Paned ra tianble(FBI) • F.E 8 I ( 2O 1
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
gnnffi field.ono Wong is ) 22-4- ,1 rcatlon:3-374-A Ist,`a:;rtizwiccn Prrnai :g UFO
3s° 4' 2.3° x s75° ZS' tot if
• w I I:16r—' 4-Ali _ 7-z;y
6.Ts(are)1 ewell(s): t ermanent or °Temporary Spud=otc oaWncmtmewr Date
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-
T.Islhlsa - � ® ���S�l°°°�l/ie�bYaaNfyuaial�evrJt(s),vV(woir)aar�mcbrdmaaoanamra.,dth-
repair an gwelt .°Yes or I!Nd ISANCdCO2C AIOn or15ANC4CO2C.0290 fWdl Cammmton&a dads and that a copy
• lft1dsisa repair;Jill end nweJI eenstradioninfamationandearptainhenahneoftie oftlosremtd&as6eenpiovtdrdmtbewdloraer_ _
meek tarderd2l email=section area the back ofthisfosm 23-Site diagram or additional well den
$.For Ge oprobeR T or Closed-Loop Geothermal Wcils having the same You may use the back of ibis page to provide additional wall eonstrnt ion info
oanstmetion,only 1GW-his t.Indicate TOTALNUMBERofwells ( 'See Ova'ieRcno s Box).Youmay also attach adfitional pages ifnecessmy.
24_SUBMITTAL INSTRUCTIONS
9-Total wen dot brlw►hind saltier 1 3
Fennel:WeweUslistaadep hslfdffaem(erempt�s@2OO'm eg2@7OO') (a1 Submit this GW-1 within 30(toys unveil completion per @eera 1ow1ng:
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24a.For All Wens Original furor to Division of Water Resources (DWR),
10.Stade water level below top of casing: "'�/ (t) information Processing l Unit,1 i 17 MSC,Raleigh,NC27699-1617
!fleeterlevel&aboe=Sng,use /'
Mulder:IL Borehole er: r (In.) 24b.For Infection Weds Copy' to DWR,Underground Injection Cmmol(1UC)
• Program,1636 MSC,Raleigh,NC27699-1636
12.WeIIcoastraeftonme#hed: r' ' R61441 24c_ForWater Supply and ODen-Loop Geothermal RdnraWells:Copy tothe
(Le-Wire.Unity.able,&1apas1.etc) couidyenvihanmental bed*d ofheconnty b4ems led, - - "
FOR WATER SUPPLYWRL S ONLY: .!
24d.For Water Welts producing over 100$00 GPD:Copy to DWR,CCPCIJA
13a.Yield(gpm) /S.- Method(nest ,P"Trip Permit Pmgram,1b11 MSC,Ratehgh,NC 27 1611
136.D1siafecfiontype::kleei fAlY Amount I'Z lb
• FaunGW--I
Nate CmoTom Department ofF�isnoamrmal QoaTasr-Division of WaferBesonoes Revised 66-2018