GW1--02873_Well Construction - GW1_20240510

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WELL CONSTRUCTION RECORD(GW-I) FrorlillYie OiLly: - -7 .
1,Wen Contractor Inform:40m
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'il4Y3VATERZOPIES,;:z.v.i 1-::;-:.,:4:-,?...•,;-%O.,•1:-'i,-,;,..1:1;::•-:'..-,-:,?.:1-'.'.. -i.,:'.,'--.••'-g.-:-::•.'7.; •..,: •
*ell Contractor Name -' - -- FRO.1 TO VESEMPTION I 1
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NC Weft Contractor OnttificaticeiNtlinber A • -y.16213ttrootasotOtrivieuttl trinolattluntst at ' ' Vi':-..- ..71.--•;-,-,-
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Company Name
• Flij bili...0 0101
2.Well Constructioarerrill#: go b •- • FROM TO =mem- , ,THIOCNIME- SIATEEI-AL
Met all applicablewell constractionpeanits(Le.WC Conn%State--.Vattanc%eta)-- — ft. ft.it. _
3.WeU Ilse(dteckwdl use): O. in.
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Witer Supply Wen; • " ,
*ROM TO DMMETFR 4.,..U.SIZE MICENISS MATERIAL-7,
Agricultural OblunicipaPPubk ft, ft, In. :+ ;
Geothermal aleatineCooliog Seat) Eltesidentiall Water Stwly(single) ft, iL In. ' + •'
TIAIMAIWOMMIRMIEI '
.._ 11°44a11/11/Wilk;SuPPIY Oared) AILGROttr, ::."6M.:;•;6.'.,:!•.•:--';:,;':•;;',....•'.:=i-:::Pi•V;:1-•-••i:Ji;r.".•,' ,::•:...,----.....-a-,;,:;•,:: •-•• :•'
• 'Ration most TO - maaiiava. • Earts.snmutir sigittOn o Ititotarr
NottMuter SUppky Well t. , •
. ft, r .' .aLk.4 ,s
blanketing ' . . ORecovery ' 0 IL 20 a.
Injection Welk -_-
Aquifer Recharge DOMurtiwtter Reesedia. tints .
:at.saNDN-fliA— VELPACKftfii blr : :•-;..- 4,0.•rf--::- ...-••::•:.,..,..:.,•:-. ...:-:•.,-.- ...T:
Aquifer Storage and Fecovely E3Salinity Barrier MOM I TO MATENIM. i .' EMELAC'EMENT!MEDD
, Aquifer Test riStamenter Drainage it ft.
Esiperimentel Technology risubsideucc Cadrol It. if. "
Owthenual(Closed Loop) riT., - :,.....A.ti.....,...............iiii....,,.:._.:,......
MOM TO DESCRIPTION(Wm'kudos=steMmktirpe.graisi ifikttc,)
Geothermal(HustiniCoornig Return nOther(celain un der fr21 Remarks) it - - . •
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4.Date WdI(s)OmsPletcd:1-14//1-4 Wfil ID* ' : I : . ": gi°%tr::,. 1147:- .itf...,-,.., . .....,—..,,..„..., _
SO.Well Locution; 3 il "' 5 1- mei 6,44:1- c,
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ft. n , '' s.----- --...i.... i v cu ..
F4conyllOwna Ns= ra4ity ID#(ifapplieable) r ,
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MAY 1 in 2g2 1
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Physical Address,City,and Zip it a. : • -
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&Flinty Parcel isfeatcatioallo.(PRO --—
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db.Latitude and longitudeindegreeshnbuttes/seconds or decimal degrees: — • : .
Of well Sold,one let/long is sufficient) 22,Cei11Pfi4jOlat j '
c-35,4gI1 / 7 _ w
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6 stneuregfc.aia.IVO Contractor Is(nre)the well(s)E1Pormanent or nTeiliporat7 "
• .By 08tting this form I hereby Geri*that the well(s)was(wen)cangnrcted in accordance
7.Is this a repair to nn cdsting we; 1:1Yes or 13No with 15/1NCIC(11 C.0100 or 1-5,11,1CriC 02C.0200 Well Constraction Standards and that a
Ardis is a repair,fill oat know well construction hfortnation a n 4 4491142in;ix Holum 9fag e°0 4."7"12"111446""w4,464 g?thyritc`mgr•
repair ander#21 mato*,section or on&chock ofthisforni.
23.Site cliaVtani or additional well*tills;
You may use the beek.of this page te provide additional well site details or wall
S.For Geoprobc1/3PT or Closed-Loop Geothermsd Wens having the same
construction details. You may also attach necessary.pagei if
COilatfUetiOn,only 1 evra is needed. Indicate TOTALNUMBER of was , additicual
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drilled: 15UOMITTAL INSTRUCTIONS 1 •
9.Total veil depth below laud surface: 16s (ft.) 24e,For„All Welts; Submit this Sinn within 30 days of completion of loll
Formal:Ole wile list all grepthslidifferent(example-3(0)209'ema201(10) egialtuelise lotto following: I: ,
10,,Stone water level below top of maim 7-59 014 Division of Water Reionrces,Information Processing Unit, , .
rwcaer level is above casinl use"4-1 1617 Mail Sereke Cedier,Reid"NC 27699-1617 '
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1.1..Borehole diarnetcr; (g A9 (M.) . 24b, 0E„J„1' nbEtimitft; In addition to sending the lam to the address in 24a
above,also submit oao copy of this FOIE within 30 days of completion of well
12,Welt onitsfxUction niethod: 1(...• Ar so.....4.„to The following:
0.e auger,navy,cable,direct push,etc.). ' - . ; :_______;
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V/4th=Resouross,lioneet lujechei" 1 Contot Program,
FOR WAXER SOPfLY WELLS ONLY 1630 Mall&nice Cet*Raleigh,NC 27699-1636 •
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method Gioia;A ir14+ 24e.E.,01:Hga-6111111hAIRISOBLWAIL: la addititth to sending the farm to
Intl:64116mi=type: cillefme,, Amount _. 0 ii the address(es)ebova,also submit eue copy of this fowl within 30 days of
completion of well constmcdou to*el county health department of the county
where constructed.
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