GW1--04789_Well Construction - GW1_20240814

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),N'F.I.I. CONST1RUC IONitl:l'l)I(I)((;\1'-I) iitriirirtnaltffe(!My
I.Well(bntiactot Information: __ ._..__._ _ .---
_ .__S1�' . 1AC1. c7ri. 1/ wAira lTInra
tp,»t TO u►M Prnnry f
IVAa( rrtacla Nine 11. fr 1
ticcL‘ P__ .._ II h I
Nt'We l f'atoare.0 redifaatton MtmtwI
1�}.UtfiF.N/ASINf.(for mint uvd urns)Up I Writ(K appnrahh9 1
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Morgan Well&i'unit , INC i�ioM kit MOO lIN I MO valor M4IPRIM.
- -_-Y-- ._- - ---.-.. 0 h. U t• a tat I" d.,7' ,/'
Comp.nr Nome I�( 11
-a 6. n 02,9„ Loll I` 1Li1'�Nrit I.A.9ltif:OR TlfbiN(7(jmlWrnsal r1me.1 ieey)
2.N`dl('nnstrncrlonPmnitti: 1/•/V f W y� -fit !._ tri pl+�f►trn Inr,K,rts uarrtrla
Bruckry'+l•ltr+tbhwr.';con,mt:elmt/malt,ftetgC,Colmar,Smw,/minnn.nr9 it. h. In
3.Well Use(cheek well use): R �. in I
Water Supply Well: Fftl1\IR�17. �70- MAM[TM- Sl.frfll/.g IilifKM►IA i fUrr0.tat, It
Agricultural QMnaicipal/i'ublic n. R. In. i
Geothermal(llesting'Cooling Supply) aResideniial Water Supply(single)
1
Ip ft, la.
industrial/Commercial ©Residential Water Supply(shared) I r
le.carers i
Irrigation FROM Tl2 --AT1t1.vI._._-_ ,►iNPLtr►MI-fR Mr'tns)I)A tNrir;srr i
Non Water Supply Well: D a. 20 a- horttree pnuM i
LIMonitaing ['Recovery ft. ft. "-"- -._._
injection Well: a rt. ••- - -
3Aquifer Recharge 0Gmundwata Remcdiation
19.SAND/GRAVF.L PACK(If appnnbte)
Aquifer Storage and Recovery °Salinity Barrier FROM TO MAT!1IAL _►MH.aCrMrM.1-kill-OPT-_.
3AquiferTest QStannwster Drainage tt. n. _..__.__.i
°Experimental Technology °Subsidence Control ft. ft. LS _ yi
DR
jGeothermal(Closed Loop) Q Tracer 20.MULLING LAG(attach additional sheets if aecenarl) J
FROM TO DESCRIPTION fc r,►ardaesc wiYrnck type,rate etae�teJ_7
',Geothermal(Heating/Cooling Return) °Other(explain under 1121 Remarks) n n. O R.
)Z 4.Date Wells)Completed: ' 3`�"Well ID!t b D. it. !r 10�n d f - __I-
5a.Well Location: S ft. /7 rt. a(0vp
Facility/Ow=NName �] ,FF/a�ciJlityID"(i(ifappplicable) . `y,,,,�
CL f, /f4,{�(ca• �r117 (I cl tt n t.. �.,•L. )/ 17
Physical Address,City,and Zip
AUG 1 4 20241
L_J,A 6,0//1 .11::RThSARKS.-Caro Parcel Identiucation No.(PiN) If,i3'."--::'r, ,')-r,r0014. up*
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: DIKE/
(if well field,one lat/long is sufficient) 22.Cer n:
3S.57 Z6E �I q N V. 0 I4 Z w 91. z- l/
6.Is(are)the well(s)JPermanent or °Temporary Si of citified We Contractor Dare
By signing tiit form,I hereby etlf that the weIl(s)was(were)ca urn.erd in accardmte.e
7.15 this a repair to an existing well: ©Yes or y�}No with ISA NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and tins_
/f this 1,a repair,fill out known well construction Information and explain the nature of the copy of this record has been provided to Me well owner.
repair under 021 remarks section or on the bock of this form.
23.Site diagram or additional well details:
8.For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only I GW-I is Deeded. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:' _ SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: O O (ft-) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdifferent(example-3 'and 2(4,100) construction to the following:
10.Static water level below top of casing: Z 400 (ft.) Division of Water Resources,Information Processing Unit,
If water level it above casing use"t" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/8 (in.) 24b.For injection Wells: In addition to sending the form to the address in 24a
12.Well construction method: rotary
above,also submit one copy of this form within 30 days of completion of well
construction to this following;
(i.e auget,nasty,able,direct posh,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-l636
13a.Yield(gpm) 5 Method of tat:sir 24c.For Water Supply&Injection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b_Disinfection type: o""jelad thicrin. Amount: completion of well construction to the county health department of the county
where constructed.
Tom:Gw-I North Carolina Department of I nvirunmcntal Quality-Disunion of Water Raoul es Revisal 2.22-2016