GW1--02606_Well Construction - GW1_20240426

WELL CONSTRUCTION RECO" GW-
Il. For
Internal Use only ! t r •
1.Well Con _ctdi Info atioee
Wetl oKN IROM TO 1' Ds(IUTION
:.. S NC Well Cont►.otor Certification . • '''' _
N ., ' . . • ': , 1B.DATER CASfl G(rot mnIH-rain.wdlr.OR LINER Of so Hrible) . .
i ., C • PROM • TO i; I1 "
'i 7ffiCKNISS 1NATMUAL
�L�IJI✓✓✓lIIJrYYr>,1�L�' J/6� :R t"
• ' / , ' �L 16.INNER CASING OR TUBING( thermal rimed-bep) ,• ' .•
2 Well Cotalrnetion Permit•iX / t/ 7 PROM TO.. DreMlrme••: vmatriraa iimmium.
• Lfst all applicable well eoruhrret/on permit:(!.a;WC County.State,Variance,'le) q-./'•R. ;cf0.1 ft,. c 5 f .ifs. 7
' 3 Well Use(cheek well use): ft �nj 4 le /
'° Water Supply Well: , - 17.SCREEN " .
OA cullllnd PROM"• TO tad '• inAmsriR. scars:Tx .7fliCI0ri53 IA MATLRL OMianIcipel/Publlc •. � !
OGeothennal(HeatingfCeoling Supply) 9 ldentiel Water. Supply.(single) _.._. .n '
�Indtrsfrio1 Curnnrercial /pResidentie!'Water'Supply(shared) • , .
Oltri do lg.CROUT.
p . O Wells>100,000 GPD • ,' PROM•: TO MA DMPLAUint ,MLIROD si*MOUP
Non-Water Supply Well = • v IL Z/ 1,n . . .•.�,
OMonitoring ORecoveiy n •-X! :
Injection Well . n r�t;� �„UAquiferRecharge OaroundwaterRemediation ;e:,
0 .a
OAquiferStorageendRecoyery, '. OSelinityDarrier /9.BAND/GRAVEL Fiat Ofapplleybls) : - , : ,' , , R::•..
PROM TO• •e MATERIAL. IMtlACatf
OAquiferTest ., OStormwater Drainage f. iNrMtrnoD
UBxperimenlel Technology OSubsidenoe Cottrell' (G
OGeothennel(Closed Loo • tt :, : r '
i
p) OTracer 20.DBfl GLOG(atteehaddlHond.heebtfnecenaq) .:
, ' PROM r.,
OOeothennel OieatinglCooling Return) ,' OOther(explain under O21 Remedrs) D�C�noN fn.y t„od.eo,r.wnct yse.P,b.tz ee,�,)
i4.Date Well(s)Completed L L Zy ro
: Well ID# tt.,
Se Well ,. �1
Location tt. • •i tt. -':.+".c:P'1 k i i 'i•.
L-ee.`A► it �i �(,t",.,/wed n Mc Ki t 1- . ` n 'n.. 'APR:'2,•,,. :2024
Facility/Owner Name' / ' Facility)D,(if linable �. ft. R: ;
1 / C�;1'r� V•• r \V`�i h . � �.� r
i1. fi3OR Ant.•B "T i,Cite. ,,
Plryak Addreee,City,end Zip R. s(('r i
l/VV 1/. 21.REMARKS/ ..1 . , '
County, Parcel Identification No.(PBS !
56.Latitude and longitude in degrees/ndntttes/seconds or decimal degrees:'
(ifwe/ll Sold,cue IdAone is n$ekat)• • /yam ,
'� ,, r73 V, . G,I 1.. N.. L \ /.,, I. I` .. ..22.Gerlitie.. . _ %�' ^ - "- - -
.f 6' as' W ,I
.„...„...,..„,......, , -:,,,,,,ii,,,6•I,�« the�r�u�. �4tt'sj"' '� G-' ';
( ) O• ht' rmanent or, OTemporary' 2r� ! ., Stsmtme :? !We} • •a� Well Contractor � .'Date� ,
7.Is ibis a,repair to anexiattngwep Oyes'"or•. .Fy:freakihtrjoim ihe►ebyeenijy that the►Pell(:)Wo2 i,,,)een,tnrcredhia,,c„nl,,,.,exl►1
this Ise' L�Ifi / , , .- ' ' ISA NCAC O7C:0100 oPLIA• C.4C VC ow 0 Well Cpn tryeNon Standa r',and that a eeA
re 'Upon-,2l fill out blow,well construction!emitted/on amiesplo/n the name of the. al ate regard has beenprev/ded to the trey owner.
••,tepalr ruder d]i smooths section or on the bock Ofthti form. '
l 23:Sitedingram or additional well delnile: "'. 'S.For Geoprobe/DPT'or Closed-Loop GeothermalWellshaving the You may use the back of this page to provide additional well eotrahnetien info .
construction,only I OW-1 Is needed. Indicate TOTAL NUMBER of month (add SeeGvei'in Renierks Box).Youmay also-attat:h additional Pages it neee y,.
drilled '
24.SUBMTITAL INST• RUCTIONS
9 Total well depth below land surface: ', d .
Formultlple irelle list all deph:yd(/jae►n(example-3@.700' @l00) (ft.) Submit this GW-1 within 30 days :•; , ,., of welFcompletion per the following ,;,`;•
10.Static crater level below top of casing: /. A 24n. For All•Wells Original font to Division of Water`Resottrcea
{twofer level I.abovegaiing;*ere"+" , _ • (�) • Information `'' (DWIZ).
rocessing Unit,IG 17 MSC,Raleigh,NC 27699-1617
'` 11.Borehole diameter. :/ - � ` •" �`• � ' - •• - �:':
. • {In) 24b.For in nail_ on Wells:Copyto D
• Program,1636 MSC,Raleeigh,NC 27699 636 Underground Inlechon Cantml(lUC)
12.Well construction`method.''-:I Q "pj
(i.e.anger.rotary,cable,dheet push,etc.) • .. 24e.Far Water Su f1 "itnd '
•. • , , ,:county envtronmetlt e O erte.men Ge e c county
Retain Wells.Copy to the
.;.,;''.....:',...'-,-.....•y(.,`,I.:,'',,..-.'...1.:,„: FOR WATER SUPPLY WEL eperiment o e county ere test
LS ONLY: .. •� ,� "• ..
.' '.• 24eL Far Water:`Vells rodudD over 100 000 GPDc•Copy to DWR,CC CCUA
13s.Yield I(gpm) Permit rogram, SC er
• ,: 1Glethod of teat �,,[ • ' g ;NC 27 99 1 �
136.Dicinfeetion type: f' / / ' _. ' , ., ... ...,tr _'.
�0 Amount. f?� < .,:..