GW1--01801_Well Construction - GW1_20240320

•
•
WELL CONSTRUCTION DECO . -
G -1W • For 7ntemaUny; ;'" .. , .1.WC on ctoAppal
U.WA
Well Contradot'Name, , •. ,, _. -
PROM TO DP QUPIION
.'' ,. .353 S....-- • . '• • /6 o ft' 'SO it•. 1 ' • • . •
•
NC watt conaagar CmNSc:tiaaxnmber . ' • •fa ra • •'
�Q�J-0 non .SR TO (for motti-sized wells OR LINYR Of ap Goble)
/ ".`v •.v✓ FROM . TO ,
ConrprayNiwn ft. I DfAM1LPlr[ B ' '•.. -S MA7LRIAL -
2.Well Permit&• 0 9.7/w 16.INNER CASING OR TUBING(geot4erm.l clpeed loop)
Lid ad applicable well Construction Per orlon prndli(le Ultra Corory,Scats Yarianes e/eJ PROM. • TO•' nurdsu i •. Ta�ISS MATZIUAL
-f-/ 70 �s�lr ,p
3.,WellUse(check well use): • ( .fL !t^� 1Z' ,}, `
. in.
- Water Supply Well: • • ,17.SCREEN.
OAgriculttual. pMunicipol/Public•• - PROM rt TO DLAMrrrR SLOTSIZI I.THICKNESS MATIRIAL
. OGeothernlel(Heating/Coolingft iv
OResidetUtiel Water Supply(single)
Olndustrial/Cammerciat. ORestdential'water Supply i°
• °Irrigation •• ' . nPP Y(s1d) la.GROt7T 6 ,
OWclls>100,000 GPD ' FROM TO• Noa Wate_r Supply WelL ) n�i AetrurrrM .€- &.►Moum
�8 • °Recovery • !z r
Injection We1L• '��L t�Q.
npr1 Iz .t,.�
' OAquiferRecharge .' ' OGroundwaterRemediatien • n ft 1— .
OAquiterStorage and Recovery, OSallnity Barrier 19,SAND/GRAVN,LPACK N'ampUcable) • ,
PROM.• . TO •' OAquiferTest, OStomtwate+Drainagen • '_ tteQtACrM�trMtrr$oD .,
°Experimental Technology / °Subsidence Control' ' t.' ,•." '
•
DGeothennal(Closed Loop),. •,r!•- • °Tracer • '20.DRILLING LOG(attach addl6owl abeeb If newury)
OGeothermel(Heating/Cooling Achim) °Other(explain Under 621 Remarks) FROM • TO . • DZS „„or!fnls
CRIpr . baraw,,ulVruk tree,scats xixt..ta1 • ;
4.Date Well(s)Completed: 3.r5 2 •Well loll
Well Location: • • �.:<•. "^y .
Fur'ity/owuuName " ` • MAR :2 0 2024
/r ` •. Facility IDM(ifappi ca ) ft ft.
4 e u ,1 OI� :�t7 Cross ;rt =z c�r.:.`.
Physical City and Zip C r�Cl.sft. ft. G�r%t,3'JC-
rAj l •
�" A�l� 21.REhIARIfS
, • • • , ParealIdmtifiationlfo(MN)
5b.Latitude and longitude in degrees/minutes%seconds or,deelmal degree •
(ifwell held,eon lat/iong is auffigeni) ,
. ((9/ „ !14. ,3 if.i / 22.CertrficaHon: "
s , � �_z:.
6.Is(are)tie well(s): I4rmanent.•or, °Temporary ' ' t 3Y� •,. igoabme b ertih' ell Contractor r • •.
7.Is lib a repair to in eibtin - -• 'y sa a I n I Data c
B al In t0ti .0100 iSVI rr C 2C 02e0rrelCparanJeon'Stancardaeaorduaw •P g well: °Yea to .' No• 1SANGlC01C:0100ef 7J,1 NCAC 02C.0700 iYeUCpirruucdon Srarrdardr and flat o
ern!:is a repair,fill out,mown well co lter:tdlon '' .
- ' -repair under i7/nmarks=don'or on the back ofthtr for , the naaa a of tha olthtr neoid has b'esn provided to Ois wsG owner • copy'`'
, . ;• 23.Site diagram or•idditional weII detaib ,`8.For Geoprobe/DPT or"©sea-Loop Geothermal Wells having the some .' You may 113e the..badi of this pogo to provido additional•well construction info •
construction,only i GW 1 is need Indicate TOTAL NUMBER of wells (add'See Ove'in R4niarks Box You drilled: � )• may also aftech additional pag .esifnecessary. r.
. ' 24.SUBhII1`TAL INSTRIIONS
9 Toial well depth below tend surface: 3 5Q •. ' • .• • • • ••
Far multiple wills Onall aprha pleirent(ewarple-3@200'and 24)/00') . (ft.) Submit this GW-1 within 30 days of well Reompletion per the following
• •10.Static water level below top of casin (Q (� ,„•,. 24i'For AU g- Well!: Original font to Division of Water Resourcea (DwR),
Ifworer level tr above ea:lny:are"+ `. - lnfctmation Processing Unit;1617 MSC,Raleigh,leigi,NC 27699-1617..
11 Borehole diameter I •in) • 24b.For Inleetion Wells: to DWG Und ' i and
• ProSram,16361r1SC,Raleigh, �o InJxtioa Control(IUC)
•
12,Welt construction rneWod: • A� . NC 27699=1636:• '
(2 Weir,rainy.nstr able direct pvab,ob,) ' ` . . , 24e.,For Wafer Supply and Open-Loop G otbermall(etori;Wells:Copy to the
FOR WATERu°tY cnvunnmenlal health department of the county where installed . ;
SUPPLY WELLS ONLY:
• • 24tL For Water Wells proddr3np over.1001000.GPD Copy to DWR,CCPCUA• . •13a.Yield(gpm) . L�O D • "Method of teak �' : -• • •. per_t P06 .1611 MSC,Raleigh,NC 27�99-I611 •
136.Disinfection type ill •
• / (�Y j t'
I_ Ainounk Z . .
Form OW=1 Narth Carolina .
D-4aranent ofEur.roamentel(1'14 y-Division of WaterResoarces ' 'I :._,_.... .