GW1--02487_Well Construction - GW1_20240423

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- . WELL CONSTRUCTION RECO ; (GW-12 ' . For Internal Use 6nly '• ,
1.W 1 Contract .Iaforgrrti
F' flReheca, i Id WATER 'NIS . I I
Well CoatRe4orName PROM TO iDPSCRE 7ION • .
. " • 3'53- 5 . . ► ft. 324 '� II I.-
NC Well Coatraetor Cmt(fiatioaNumbQ ft. tt
fL IS.OUTER CASINO(for multi-cued welt OR LUNER(if so Gnble) •, •
A.ti�. /J/`]•`_^_ / a I
Bo ` To . _ I •DL1MSrnt . TRICORN MATIIWL'. _
CouyagyNaom R R. ta.
2.,We11 Construction Permit#: I �� lf.INNER CASINO'OR G(Re�thernal doled-bop)
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L PROM TO - - DIAMaUR THICKNESS MATZIUAL Lot all appllmbrs well con naectlonpennhf,(t e.UIC,Coanp.Stare lfariana.era) (t qif R• C 7/i/-(o
• 3.Well Use(cheek well use): n• ft. r� I �
WaterSupPlyWell: 11.SCREEN .
° CUltulel PROMI.TO . DIAMrI=R SLOTSIZZ THICIWPSS MATERLIL .bMunicipal/public ra
DGeothennaf(Heating/Cooling Supply) A identiel Water Supply(single) -i' is -
OlndustrieUCommerciel iG R s la'
• Residential'Water Supply(shared)
' Olmgatiop - OWells•>100.060 GPD ' " • nom'• TO •
- --. Nod-WaterSup0ly.Well: .' - - -
_ M�►T al-
lu�r.+cn�rrbarsoa e�nMotnrl'
•
•(]Mooitonng ORecov Oit. Z `� L t+f m,y.t : ,
' Injection-Well:orin •. ery - , (t . • / .tt ,
. r'r del tv►�
OAquiferRechergo . OGroundwaterRemediation ' lG • n i r
OAquifex.Storage end Recovery °SelinityBerriet 19.IROW/AVELPACKOfappUeable) • .
OA uiferTest ' . . , . arraoa
q • OStormvraterDraimge ' R
OFacperimeutai Technology. OSubsidanoe Control' R �,
°Geothermal(Closed Loop) •• • • • .°Tracer •• • �` t •'
20.DRILLING LOG(iftaeL idditional abash fraeeatarr)
°Geothermal(treating/Cooling Return) °Other(explain under#21 Remarks) PROM TO . DESCRIPTION(afar,birdmen,ulUnck type,pat,size,de) '
4.Date Weil(s)Colmpl e " ( ;ZaF R i eted f Well DJ# IL $
5a.Well Location �! �C;�.. . .'`( t•-m ,$ l
FaeaJ'tpoettA i-; e-1 .�Y . . ' . R f ' . - ? APR r� /fi/t •.
• Facil •ity N R S" •
SWG 1 n�i,/ .i I'ra �)1/ I applicable) ,R < •:r :c, f� i�r" r
•
Pliiiiau lAddnau,City.and Zip R If r , v Q
It) f 4111'A - 21.REMARKS! ii
Camty ' Pa ccl ldenlification No.(PIN) ..'
' • 5b.Latitude and longitude In degreea/miuotea/second,or decimal degrees: ' . 1
• (if well field,one lat/lona is auMcieot) - -'
t • 22.Certi6ca'on:
3b :21 �3 'N • ?/ 1 6 r 4'1 - ` ,,� i
•
6.Is(are)the well(s): cr'manent ' or - OTem era Se vT _ Z�
— P !�' �_ - - --- — o CehS •WellCoutreetor . Dare - .. . --
7.Is thb,repair to as existing well °Yes or. ByrfsninEeh&lona.I*eh;cargoMai rhewsil s war ' •
No• 13.1 NCAC 01C:0100 veinNCAC 01C.0200Wel )eon Standards
a ndduiru op '
If this Is repair fill oinlnouu rre0 anurnecti n bi ormar/on aln Ma nahaie((the olrhb record has beenprcvidedto Me wa0bw»a t COY Srandm�dr and that a copy,
"repalr'weler ill remarAsseu/on or on the backofth/sjomr. '
• 23.Site diagram or additional well details: • -
8.For Geoprobe/DPT or Cloied-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
Construction,only 1 GW I is needed. Indicate TOTAL NUMBER of wells (add'Sec Oven'm R tmarks )Box.You drilled: may also atbch additional pages if necessary- '
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24.SUBMITTAL INSTRUCTIONS '
9.Total well depth below land surface: •
FermuUQle wells list all dentin Ijdlfjennr(erarnwle_3®J00'mid 11100) (ft.) Submit this GW-1 within 30'days of wei,completion per the following: '• . '
10.Static water level below top of casing: 2 V 24a. For All Wells: Origin,' form to Division'of Water Resource,'
• "(water level b above cash&:ure//'+'/�f (f t) Information Processing Unit,I617 MSC,Raleigh,NC 27699-1617 ••
11.Borehole diameter. - (� li a • •(m.) 246.For Pulsation Wells:Co to D
)ry WR,Underground Injection Control(IUC)'
12:Well construction method:
• . ' '•1(j) 4 —.• • progruq 1636 MSC,Raleigh,NC 27699-1636
(i a user,rotary table,duet peulti eta) 24c.For Water Supp and Open-Loop
ly Geothermal Return Welb:Co to the '
' • ty ea 0Ntlultal h
th de ar n ea•t of the county as installed' . FOR WATER SUPPLY WELLS ONLY:' . • ;. - .. !
24d.For Water Wells roadrlr .orec,100 000 GPD:Co• to D
- ' • 13a.Yield(gpm)• - ' .5 • •• Method of teat: r • Pmmd Program,' 11 MS . WR CCPCUA '
C, of 'NC 27699-1 11
136.•Diainfeetio f /! I - tti
s type' r Amount: �✓ , i
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